Site enrollment

How better qualified referrals lower screen failure rates

By TrialNotice · Updated
Hands sorting patient folders into green tabbed and amber tabbed stacks on an oak desk
Short answerScreen failure rates fall when the patients coming in are closer to eligible before screening starts. Tufts CSDD puts the average screen failure rate at 36.3% across therapeutic areas and 57% in CNS trials. Referring physicians already know most deciding criteria, such as diagnosis, medications, and prior treatments, so a referral source built around clear criteria filters patients before the site spends screening resources.

How high are screen failure rates?

Tufts CSDD studied 76 Phase II and III trials across 7,085 sites. The average screen failure rate rose to 36.3%, up from 34.7% in 2012, and in CNS and neuroscience trials it rose to 57%, up from 29.5% (Tufts CSDD via Applied Clinical Trials). In MASH trials, it runs 70 to 80% (JHEP Reports).

36.3%
average screen failure rate, all therapeutic areas
57%
average in CNS and neuroscience trials
70 to 80%
in MASH therapeutic trials

Why do screen failures cost so much?

Every failed screen uses staff time, labs, and sometimes procedures. In one 25 practice trial, sites screened 7.2 patients for each one randomized on average, and recruitment took 3.7 staff hours per randomized patient (PMC).

How do referrals change the math?

A referring physician already knows the patient's diagnosis, medications, treatment history, and recent labs, which are the criteria behind most screen failures. A meta analysis of recruitment channels found that offline methods converted better in 69% of studies that compared conversion (JMIR). The key is giving physicians the criteria in a form they can apply from memory.

What should a site change?

  1. Track screen failure reasons by source, so you can see which channels send the wrong patients.
  2. Put the deciding criteria at the top of every physician summary and prescreening script.
  3. Tell referring physicians why a patient failed, in general terms. Their next referral will be better.
  4. Prescreen by phone before any in person visit.

Physicians cite missing information as a main reason they do not refer (Tufts CSDD). Clear criteria improve both the number and the quality of referrals.

Get your study in front of the right local physicians

TrialNotice builds a physician referral pipeline around one active study. We identify relevant local physicians within driving distance of your site, send study aligned direct mail, follow up by email and LinkedIn, track engagement with recipient level QR codes, and route warm responses into your site team's workflow.

Talk to TrialNotice

Sources

  1. Applied Clinical Trials, "Can Recruitment and Retention Get Any Worse?" (Tufts CSDD screen failure study)
  2. "Non invasive tests for fibrotic MASH for reducing screen failure in therapeutic trials," JHEP Reports, PubMed
  3. Brøgger Mikkelsen M. et al., "Online Patient Recruitment in Clinical Trials: Systematic Review and Meta Analysis," Journal of Medical Internet Research
  4. "Site specific factors associated with clinical trial recruitment efficiency in general practice settings," PMC
  5. Applied Clinical Trials, "Tufts CSDD Study Explores Low Recruitment Rates"

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