Referral Acceptance Research Articles

Individual and clinical factors associated with patient acceptance of referrals to social services and community resources at a multi-purpose resource hub.

Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.

Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications

ABSTRACT HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV.

Health Navigator intervention to address the unmet social needs of populations living with cancer attending outpatient treatment at a major metropolitan hospital in Australia: protocol for a mixed-methods feasibility trial

IntroductionIntegrating health and social care to address unmet social needs is an emerging priority for health systems worldwide. Screening and referral interventions for unmet social needs, also known as Health...

Acceptance of electronic referrals across the Kingdom of Saudi Arabia: results from a national e-health database.

An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance. This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals. Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69). The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

Patient accessibility and utilization of behavioral sleep medicine referrals in an academic center.

Behavioral sleep medicine (BSM) is a subspecialty that combines behavioral psychology and sleep medicine specialties. The objective of this study was to analyze referral patterns to a BSM clinic. The 3 specific aims were: (1) describe factors that predict referral acceptance, (2) identify barriers to attending initial appointment, and (3) describe variables associated with the number of visits attended. Retrospective chart reviews were conducted as part of a quality improvement project by this study team's clinical setting. Adults over 21 years of age who were referred to a BSM clinic in an urban Midwestern academic health care system between 2014 and 2019 were included in this study. Sleep medicine was the main referral source for patients with BSM (74.2%), followed by internal medicine (9.3%) and neurology/psychiatry (7.3%). Thirty-eight percent of patients did not schedule an appointment after a referral for BSM was initiated. Younger age, longer distance from clinic, commercial insurance, and out-of-network insurance were all significantly greater for nonschedulers. Eighty-three percent of patients did attend the initial intake session with BSM providers. Older age was associated with lower likelihood of not attending scheduled BSM appointments. Patient characteristics of older age, closer distance from clinic, and in-network insurance coverage were found to significantly increase the likelihood of BSM scheduling, while younger age, Black race and not getting a primary sleep disorder diagnosis (vs a diagnosis of insomnia disorder) and shorter days from referral to appointment were associated with an increased likelihood of not attending the scheduled BSM treatment engagement. Chernyak Y, Ofner S, Williams MK, Bolarinwa C, Manchanda S, Otte JL. Patient accessibility and utilization of behavioral sleep medicine referrals in an academic center. J Clin Sleep Med. 2024;20(11):1793-1806.

Referral Efficiency for Veterans with Osteoarthritis: A Quality Improvement Project.

Management of osteoarthritis, a common disease among veterans, includes referrals to orthopedic specialists. This requires an effective referral system. The aim of this study was to evaluate a quality improvement project addressing inefficiencies in the osteoarthritis referral process between primary care providers and orthopedic specialists. A pre- and post-intervention evaluation using medical record review and provider surveys was conducted to measure the process improvement of a primary care to orthopedic referral template. There was a 3.5% increase in the referral acceptance rate following the intervention. In addition, primary care providers perceived that role clarity and perception on making referrals had significantly improved. The largest perceived improved change among orthopedic specialists was in communication. A simple process change, such as improving the referral template, can help with communication, data transfer, and referral acceptance rates between primary care providers and orthopedic specialists. This in turn will benefit the large population of veterans needing orthopedic referrals for management of osteoarthritis.

The Prevalence of Depression and Acceptance Rate of Referral to Psychiatrist Among Psoriatic Patients in Saudi Arabia.

Background Psoriasis is a chronic inflammatory disease that primarily affects the skin and can significantly impact the quality of life. Previous studies have shown that psoriasis increases the risk of depression; however, there is a lack of information about the prevalence of depression and psoriatic patients' acceptance of referral to a psychiatric clinic in Saudi Arabia. This study aims to estimate the prevalence of depression among psoriatic patients in Saudi Arabia, determine their referral acceptance rate to psychiatric clinics, and assess their knowledge regarding the impact of depressive symptoms on psoriasis. Methods This questionnaire-based cross-sectional study included patients with psoriasis who presented to dermatology clinics in Saudi Arabia. All patients were instructed to complete three sets of questionnaires encompassing sociodemographic information, the clinical characteristics of their illness, and the Beck Depression Inventory. Results Of 406 patients, 54.9% had symptoms of depression, and 46.3% were willing to go to a psychiatrist when symptoms of depression were present. Most of the patients (70%) thought that depression affects psoriasis. Conclusions More than half of the psoriatic patients in this study were depressed. The patients understood that depression can lead to a worsening of their symptoms, but the majority refused to see a psychiatrist. To remove barriers to seeing a psychiatrist, psoriasis patients should be provided with mental health assistance, taught to identify psychological stressors and effective strategies to cope with these stressors, and educated about available services, including telemedicine.

Opportunities lost? Rates and predictors of attrition in an eating disorders outpatient service

ObjectiveTo examine rates and predictors of attrition from referral through to treatment completion in an outpatient public psychology service's eating disorder program in Perth, Western Australia. MethodThe proportion (number) of clients (N = 671; mean age = 23.8 years) transitioning between stages of pre-treatment and treatment was identified. Associations between demographic, treatment and clinical variables and attrition were investigated using logistic regression. ResultsOnly 34% (n = 230) of referred patients started treatment and 16% (n = 107) completed treatment. Referral acceptance was correlated with provisional diagnoses that meet the service's inclusion criteria, and attendance at an initial assessment was correlated with younger age. Treatment commencement was correlated with the presence of a co-occurring depressive or anxiety disorder, and no previous suicide attempts. Completing a full course of treatment was correlated with no previous hospitalisation for psychiatric issues, no previous suicide attempts, a history of psychiatric medication use, and treatment with family-based therapy. DiscussionHigh rates of attrition were found from referral to treatment completion. A suggested framework for defining the different stages of attrition is proposed to allow for consistency of attrition reporting across the mental health field. Future studies are needed to identify why clients disengage following referral, assessment, and treatment commencement, to inform strategies to engage and sustain engagement and to optimise outcomes.

Increasing Referral Acceptance for Women’s Health Services Among Hispanic Women

ObjectiveTo evaluate the effect of an individualized educational intervention on women’s health referral acceptance rates among Hispanic women. DesignQuality improvement (QI) project. Setting/Local ProblemBarriers to cervical cancer screening among Hispanic women include a lack of access to women’s health services and a lack of knowledge related to cervical cancer risk factors. Primary care providers at two medical clinics in eastern Pennsylvania did not routinely discuss cervical cancer risk factors, provide well-woman care, or perform cervical cancer screening during office visits. This gap in preventive care provided an opportunity for quality improvement. ParticipantsA convenience sample of 65 self-identified Hispanic women presenting for primary care office visits. Intervention/MeasurementsEach consenting participant received a one-on-one education session lasting 5 to 10 minutes regarding individual risk factors for cervical cancer. Each woman was offered a referral for a well-woman examination, with or without cervical cancer screening. Data collection included the participant’s response to the offered referral. ResultsThe majority of participants who received the educational intervention (96.9%, n = 63) accepted referrals for women’s health services. ConclusionAn educational intervention discussing individual cervical cancer risk factors was associated with increased women’s health referral acceptance rates among Hispanic women.

Impact of an APRN Directed Workflow Change on Outpatient Palliative Care Referral Acceptance Rates

Impact of an APRN Directed Workflow Change on Outpatient Palliative Care Referral Acceptance Rates

Acceptability of automatic referrals to supportive and palliative care by patients living with advanced lung cancer: qualitative interviews and a co-design process

PurposeTimely access to supportive and palliative care (PC) remains a challenge. A proposed solution is to trigger an automatic referral process to PC by pre-determined clinical criteria. This study sought to co-design with patients and providers an automatic PC referral process for patients newly diagnosed with stage IV lung cancer.MethodsIn Step 1 of this work, nine one on one phone interviews were conducted with advanced lung cancer patients on their perspectives on the acceptability of phone contact by a specialist PC provider triggered by an automatic referral process. Interviews were thematically analysed. Step 2: Patient advisors, healthcare providers (oncologists, nurses from oncology and PC, clinical social worker, psychologist), and researchers were invited to join a working group to provide input on the development and implementation of the automatic referral process. The group met biweekly (virtually) over the course of six months.ResultsFrom interviews, the concept of an automatic referral process was perceived to be acceptable and beneficial for patients. Participants emphasized the need for timely support, access to peer and community resources. Using these findings, the co-design working group identified eligibility criteria for identifying newly diagnosed stage IV lung cancer patients using the cancer centre electronic health record, co-developed a telephone script for specialist PC providers, handouts on supportive care, and interview and survey guides for evaluating the implemented automatic process.ConclusionA co-design process ensures stakeholders are involved in program development and implementation from the very beginning, to make outputs relevant and acceptable for stage IV lung cancer patients.

Pharmacist-implemented intervention to surmount COVID-19 vaccination hesitancy in adults with substance use disorders.

Substance use disorders (SUDs) increase the risk and severity of infectious diseases, including coronavirus disease 2019 (COVID-19). Adults with a co-occurring SUD and psychiatric disorder were studied to elucidate the association between SUD severity and (1) COVID-19 vaccination status, (2) receptivity to a one-session intervention with a pharmacist advocating the benefits of vaccination, and (3) acceptance of referral for vaccination following the intervention. COVID-19 vaccination status was recorded in 460 adults with SUD (324 males and 136 females) upon entry into inpatient treatment. A 2-parameter item response theory (IRT) model quantified SUD severity. Pharmacist-delivered intervention, modeled after the screening, brief intervention, and referral to treatment (SBIRT) protocol, was offered to unvaccinated participants. Higher SUD severity was associated with a lower vaccination rate. Nicotine, opioid, and sedative use disorders were most frequently associated with unvaccinated status. SUD severity was not associated with receptivity to intervention advocating vaccination or subsequent acceptance of a referral for vaccination. The portion of the sample that received the intervention was over 7 times more likely to accept a referral for vaccination when compared to participants who rejected the intervention (20.8% vs 2.8%). Pharmacist-administered intervention produced motivation for vaccination in a number of recipients; however, receptivity to the intervention was not related to SUD severity.

A referrals audit and qualitative analysis of staff experience of referrals in a specialist community learning disability service

PHOTO CREDIT: Aaron BurdenSpecialist community teams are set up to support people living with Learning Disability (LD) who are unable to access mainstream mental health (MH) teams with reasonable adjustments. National guidance is available to guide best practice in making reasonable adjustments, to support increased access to mainstream services. This audit of referrals into a specialist Community LD team, aimed to establish referral acceptance rates and reasons for referral rejection. Total referrals and referrals made specifically from mainstream MH teams were investigated. A focus group explored LD clinicians’ experiences of the referral process and criteria in the context of working alongside mainstream MH teams. A lower acceptance rate of referrals from mainstream MH teams than overall acceptance rate was found, and differences in the reasons for rejection were highlighted. No LD diagnosis in the referral was the most common rejection reason for mainstream MH team referrals. Thematic analysis highlighted four themes of clinician’s experiences which focused on: referral point struggles; service limitations; lack of diagnostic clarity; and attempts to bridge a gap between services. Recommendations include review of the referral process, joint working protocols, clarification of remit and dissemination of shared learning.

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia.

Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSAduring 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these,20,523 (69.19%)were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.

Novel use of structural equation modeling to examine the development of a framework of patient-centered two-way referral systems for building digital subjective well-being healthcare: A cross-sectional survey in Central China.

Digital health technologies are progressively assuming significant roles in aspects encompassing in-hospital management, patient-centered design, and tiered referral systems. Nevertheless, current studies do not involve exploration into the potential value and mechanisms of digital health in a patient-centered context. This study aimed to explore the development of a framework of comprehensive, evidence-based digital health technologies for the construction of welfare-oriented healthcare. From March to June 2023, a cross-sectional online study was performed, involving 335 respondents with prior referral experiences hailing from the Central China region. Data on welfare-oriented healthcare factors (clinical pathway management, medical structure configuration, healthcare service accessibility, two-way referrals) underwent factor analysis in advance, and correlation between these factors and their association with two-way referrals was evaluated by testing for direct and indirect (mediating) effects. Firstly, there existed a significant positive correlation between integrative medical indicators and welfare-centered healthcare (β = 0.02-0.16, p < 0.05). Furthermore, two-way referral had an direct association with integrative medical parameters and the welfare healthcare service system (β = 0.15-0.31, p < 0.05), but exerted a partial mediatory function in the welfare healthcare service system (β = 0.005-0.021, α < 0.05). Two-way referrals partially mediate the integrated medical indicators, mainly through direct effects, while also providing complementary support. Clinical pathways, medical structure, and accessibility are closely linked to welfare healthcare and significantly influence healthcare quality. Thus, improving these factors should be prioritized. This study proposes a method combining integrated evaluation indicators with pathway mechanism design. This pathway mechanism design includes key steps such as patient registration, information extraction, hospital allocation or referral, diagnosis and treatment, rehabilitation plan monitoring, service feedback, and demand resolution. This design aims to change patients' intentions in seeking healthcare, thereby increasing their acceptance of bidirectional referrals, and ultimately enhancing the effectiveness and realization of welfare healthcare.

Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care.

People with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common. For people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition. Of the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains. Attrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work.

Treatment acceptance and its associated determinants in cancer patients: A systematic review.

Treatment recommendations for cancer patients are carried out according to clinical assessment, type and stage of cancer and treatment guidelines. However, many patients do not accept the recommendations. This raises obstacles in managing of cancers, which not only affects the patients, but also the family and people around the patients. This problem could increase morbidity, mortality and recurrence rate, which might result in lower quality of life. Since this condition is a complex problem, there is necessity to explore and determine various determinants from different levels. The aim of this systematic review was to explore the acceptances of cancer treatments among cancer patients and its associated determinants. Articles published from 2010 to 2023 were searched in four databases: ScienceDirect, Medline, Google Scholar and PubMed. Articles written in English and focussing on three main cancer treatments (surgery, chemotherapy and radiotherapy) were eligible. A narrative approach was used and the data were analysed into selected themes. Data suggest that several factors influence patient acceptance for cancer therapy including sociodemographic, economic and spiritual cultural backgrounds; patient knowledge and perceptions; community support, as well as policy and availability of health facilities. The determinants consist of individual, interpersonal, institutional, community and public policy level and interaction between levels are contributing to cancer treatment acceptance. In conclusion, cancer treatment acceptance remains a problem in particular in low middle income countries. In addition, the data on radiotherapy referral acceptance were limited and needed further study.

Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study

IntroductionGeriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM). Materials and MethodsThe study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP). ResultsOf the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%). DiscussionThe study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.

Abstract 18375: Improving Rate of Prenatal Diagnosis of Critical Congenital Heart Disease Despite the Covid19 Pandemic: A Canadian Multiprovincial Study

Background Restriction to travel, reallocation of health resources and physical distancing during the COVID19 pandemic caused extraordinary health system strain, requiring limited tertiary referral acceptance. The overall impact of public health measures during COVID19 on diagnosis of congenital heart disease (CHD) has not been explored. We sought to determine the rate, timing of diagnosis and pregnancy outcomes of critical CHD prior to and during the COVID era. Methods: Cases of CHD with due date/birth date from 1 Jan 2016 to 1 Mar 2022 that required or were anticipated to require neonatal intervention were identified from surgical and referring centres in Ontario and Alberta. Pregnancies were categorized as reaching 18 weeks GA before (pre-COVID) or after 1 March 2020 (COVID). Outcomes included timing of diagnosis (pre/postnatal), GA at prenatal diagnosis, and pregnancy outcome. Data are presented as mean, 95% CI or median (IQR); rank-sum comparison of continuous variables or Chi 2 comparison of proportions were used. Results: Prenatal diagnosis occurred in 1240/1823 (68% (65.8, 70.1)) of cases of critical CHD overall, with a pre-COVID rate of 867/1305 - 66% (64, 69) and COVID rate of 373/518 - 72% (68, 76), p=0.02. During COVID, earlier median GA at obstetric ultrasound (median GA: pre-COVID 20.1 (19.1, 22), COVID 19.9 (19.1,21.3), p=0.025) and diagnosis of CHD (median GA: pre-COVID 21.7 (20.3, 24.3), COVID 21.3 (20,23.3), p=0.006) occurred. Prenatal diagnosis before 22 weeks GA (pre-COVID 449/851, 52.3% vs COVID 219/371, 59%; p=0.043) and termination were more common during COVID (pre-COVID 28% (25,31), COVID 35% (30,40) p=0.015). Conclusion The rate of prenatal diagnosis of critical CHD continued to improve during the COVID pandemic in two of Canada’s largest provinces. Unexpectedly, obstetric ultrasounds occurred earlier, leading to earlier prenatal diagnosis of CHD. These findings may have implications for referral practices in the post-COVID era.

429 Service Evaluation of the Royal Orthopaedic Hospital Bone Infection Service in Patients with Spinal Infections, Both Native and Following Surgery - Five Years of Experience

Abstract Aim The Royal Orthopaedic Hospital Bone Infection Service (ROH BIS) is one of the four formal bone infection services in the United Kingdom, providing multidisciplinary care and community support for patients with bone infection. This service evaluation is to document burden, pattern of infection and subsequent treatment by the ROH BIS in treating those with spinal infection, both native and following spinal surgery. Method This is a retrospective analysis of spinal infections treated from 2017-2022 at the ROH BIS. Clinical, MDT and investigation notes were reviewed for demographics, comorbidities and details of identification and management of the infection. Results 39 patients (median age = 63, IQR = 34, male = 46.2%) were identified. 23 patients had previous metal implanted, 16 did not. The infection rate in ROH spinal surgery is 3%, 15 infections were native, and 24 were iatrogenic. Cardiovascular-related disease (38.5%) is the most common comorbidity. The mean time taken to identify a bone infection and infectious organism was 1.5 days and 4.0 days. Enterobacteriaceae (33.3%) and Staphylococcus Aureus (20.5%) were most commonly identified. Recurrent infection rate was 5.1%, and 5 (21.7%) cases required removal of implant. The mean number of MDT meetings for each patient is 1.7 meetings, and the mean extra hospital stay is 20 days. Conclusions Infections following spinal surgery are well managed by the multidisciplinary ROH BIS model. Rapid referral acceptance, strict diagnostic sampling criteria and specialised nursing care enabled precise management and lessened the burden of reoperation or metal implant removal on patients