myTomorrows Survey Reveals 52% of Clinical Trial Sites Say 1 in 5 Referrals Are Ineligible Before Screening Even Begins
核心洞察
A survey of 100 U.S. clinical trial site professionals finds that 52% of sites see at least one in five referrals ruled ineligible before formal screening begins, signaling that recruitment's core problem is readiness, not volume.
62% of respondents cite failure to meet key inclusion/exclusion criteria as the leading reason for pre-screen failure, indicating problems originate upstream before referrals reach sites.
59% of sites report enrolling fewer eligible patients due to recruitment inefficiencies, while 55% report delayed timelines or missed enrollment targets and 35% report increased costs.
A new survey from global health technology company myTomorrows (搜索) paints a stark picture of clinical trial recruitment inefficiencies in the United States, revealing that more than half of trial sites (52%) see at least one in five patient referrals ruled ineligible before formal screening even begins. The findings, published in a data report titled The Referral Readiness Gap: Why Clinical Trial Sites Need Better Qualified, Better Documented, and Easier-to-Act-On Referrals, underscore that the core challenge in trial recruitment is no longer generating volume — it is ensuring readiness.
Based on responses from 100 U.S.-based clinical trial site professionals surveyed in Spring 2026, the report identifies four structural pressures that are driving missed enrollment targets, delayed timelines, and rising costs across the clinical development landscape.
Referrals Failing at the Source
The survey reveals that the root of the problem lies upstream. A decisive 62% of respondents identified failure to meet key inclusion and exclusion criteria as the leading reason for pre-screen failure. This means that the majority of ineligible referrals are not borderline cases requiring nuanced clinical judgment — they are patients who simply do not qualify for the trial in question, a problem that originates before the referral ever reaches the site.
The Hidden Cost of Triage
The burden of managing poor-quality referrals falls heavily on site teams. According to the survey, 27% of sites spend more than 20 hours per week reviewing incoming referrals, and nearly 7 in 10 respondents said that recruitment workload limits their ability to focus on patient care or study quality. The downstream consequences are measurable: 59% of sites report enrolling fewer eligible patients as a direct result of recruitment inefficiencies, 55% report delayed timelines or missed enrollment targets, and 35% report increased costs, with knock-on effects including protocol amendments and staff burnout.
Fragmented Systems Compound the Problem
Technology fragmentation exacerbates the inefficiency. The survey found that 52% of sites use at least four different tools for pre-screening alone, and 43% use four or more for referral intake. Meanwhile, 42% of respondents cited delays in accessing complete patient information as a top barrier — friction occurring at precisely the point where speed and accuracy matter most.
Recruitment delays already affect an estimated 80% of clinical trials, and site teams sit at the center of that challenge, screening and assessing patient fit, coordinating with sponsors and CROs, and guiding patients through critical decisions — all while eligibility criteria tighten and timelines compress.
Sites Point to Practical Solutions
The survey also captured what site professionals believe would make a meaningful difference. Artificial intelligence emerged as a practical fix: 67% said AI could help detect potential matches for new or amended trials, and 65% believe it could reduce administrative workload. Personalized patient navigation was even more highly valued — 76% of respondents said it would deliver high or very high value, and 70% believe it could increase the share of referrals who meet basic eligibility criteria before ever reaching the site.
"Trial site professionals are telling us something we need to take seriously – that the current trial recruitment process often creates unnecessary barriers to enrolling patients in clinical research," said Michel van Harten, MD, CEO of myTomorrows (搜索). "As trial design becomes increasingly targeted and complex across disease areas, identifying patients who are both eligible and ready for screening becomes more challenging. By improving the upfront quality of referrals, centralizing workflows and making communications truly transparent — sites are able to function much more efficiently, and focus on patient care."
The survey participants spanned a broad range of roles, from clinical research coordinators, study nurses, and principal investigators to sub-investigators, clinical project managers, directors of clinical trials, and heads of site research — all actively engaged in clinical trial recruitment at the time of the survey.
myTomorrows (搜索), headquartered in Amsterdam with an office in New York City, has supported more than 17,700 patients and 3,000 physicians across over 440 sites in more than 135 countries, partnering with more than 10 of the world's leading pharmaceutical companies.