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Introduction: This study was performed to evaluate the quality of referral, triage and follow-up of medical outpatients. Materials and methods: Indicators addressing the quality of referral letters (relevance, timelines, content), triage, waiting times and follow-up were decided upon prior to data collection. Each participating outpatient clinic collected data from 50 referral letters and hospital outpatient records. Registration was performed by both a local GP and the responsible consultant. All Danish medical outpatient clinics were invited to participate. Three months after data presentation, the participating doctors were interviewed. Results: Twenty-eight outpatient clinics participated. After analysis, the data were presented as diagrams on the Internet showing clinic-specific results. For each variable, the assessments made by the GP and the consultant were compared. The overall agreement regarding the quality of the content of the referral letters was good; both the GP and the consultant assessed 23% of the referral letters as unsatisfactory. Lack of information about already performed examinations and current medication was the most important problem. The use of triage for the planning of examinations varied considerably. About one quarter of all patients underwent one or more identical examinations before and after referral. Of these, the GP and the consultant assessed respectively 24.8% and 17.5% as being unnecessary. The agreement between GPs and consultants on the responsibility for follow-up varied from 6.3% to 100%. Discussion: The design was found suitable for pointing out local as well as general issues to address in the future. The follow-up interviews supported the applicability of the concept as a tool for quality improvement.

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