Majority Of Referrals Research Articles

Utilization of Patient Navigators in an Urban Academic Pediatric Primary Care Practice.

Navigating health care systems can be a challenge for families. A retrospective descriptive cohort analysis was conducted assessing referrals to patient navigators (PNs) in one urban academic pediatric primary care practice. PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals. The most common reasons for referral were assistance overcoming barriers to care (46%), developmental concerns (38%), and adherence/care coordination concerns (14%). Significant predictors of referral were younger age, medical complexity, public insurance, male sex, and higher rates of no-show to visits in primary or subspecialist care. The majority of referrals were resolved. The referrals for process-oriented needs were significantly more successful than those for other concerns. PNs were more effective for discrete process tasks than for those that required behavior change by patients or families. Future directions include analysis of cost effectiveness of the PN program and analysis of parent and primary care provider experience.

Universal serial bus dermatoscope as an oculoscopy tool.

Lesions in and around the eye present frequently to dermatologists. For many of these, an ophthalmologist referral and slit-lamp examination is sought; however, this may not always be feasible. However, the majority of referrals are taken because dermatologists lack means to visualize the eye in detail (eg, to look for Lisch nodules). The contact dermatoscope has been used to study Lisch nodules in neurofibromatosis 1 Gómez Moyano E. Martínez Pilar L. Rodriguez Calvo de Mora M. et al. Using dermoscopy to assess diagnostic criteria of neurofibromatosis. J Am Acad Dermatol. 2015; 73: e17-e18 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ; however, the typical anatomy of the orbit and its structures limits its utility in this area.

Working Health Services Scotland: a 4-year evaluation.

BackgroundWorking Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it.AimsTo evaluate the impact on health and work outcomes of WHSS clients over a 4-year period.MethodsData were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge—EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM).ResultsA total of 13463 referrals occurred in the 4-year period; 11748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health conditions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up.ConclusionsThe WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers.

A study of psychiatric referrals from other specialties at a tertiary care center

Objective: The objective was to study the reasons for referral, to study diagnostic categories of psychiatric referrals, and to study the associations if any between reasons for referral and diagnostic categories of psychiatric referrals. Materials and Methods: The present study was conducted at the Department of Psychiatry, Mamata General Hospital, Khammam. The present study consists of 112 psychiatric referrals; 12 referrals were excluded from the study as they are not willing to give consent, so the study was conducted on 100 psychiatric referrals. The study protocol was approved by the Institutional Ethics Committee. Results: In the present study, based on the sources of referrals, it was found that majority of the patients were from the Department of General Medicine (38%). In the present study, the most common reason stated for referral was suicidal/self-harm act by 29% of the sample. The most common psychiatric disorder diagnosed in the present study was found to be substance use disorder which is seen in 33% of the sample. On evaluation of diagnostic categories with reference to reasons for referral, it is found that most of the referrals with a history of excessive alcohol intake were diagnosed as substance use disorders (91.6%). Majority of referrals with a history of suicidal attempts were diagnosed as intentional self-harm (58.6%). Referrals with a history of altered sensorium were diagnosed with organic mental disorders (50%), substance use disorder (37.5%), and 12.5% had no psychopathology. Conclusion: Suicidal attempts are most commonly diagnosed to have intentional self-harm. Substance use disorder came to be high in referrals which are referred for excessive alcohol intake. Regarding referrals to psychiatry department, majority of the patients were from the Department of General Medicine. The most common reason stated for referral to psychiatry was suicidal/self-harm.

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research is warranted to determine the optimal pharmacy service for home care patients and the most appropriate cpKPIs to measure its effects.

Predictive values of referrals for transient ischaemic attack from first-contact health care: a systematic review.

Over 150 000 cases of suspected transient ischaemic attack (TIA) are referred to outpatient clinics in England each year. The majority of referrals are made by GPs. This study aimed to identify how many patients referred to a TIA clinic actually have TIA (that is, calculate the positive predictive value [PPV] of first-contact healthcare referral) and to record the alternative diagnoses in patients without TIA, in order to determine the optimal service model for patients with suspected TIA. A systematic review of TIA clinic referrals from first-contact health professionals (GPs and emergency department [ED] doctors) was undertaken. Four databases were searched using terms for TIA and diagnostic accuracy. Data on the number of patients referred to a TIA clinic who actually had a TIA (PPVs) were extracted. Frequencies of differential diagnoses were recorded, where reported. Study quality was assessed using the QUADAS-2 tool. Nineteen studies were included and reported sufficient information on referrals from GPs and ED doctors to derive PPVs (n = 15 935 referrals). PPVs for TIA ranged from 12.9% to 72.5%. A formal meta-analysis was not conducted due to heterogeneity across studies. Of those not diagnosed with TIA, approximately half of the final diagnoses were of neurological or cardiovascular conditions. This study highlights the variation in prevalence of true vascular events in patients referred to TIA clinics. For patients without a cerebrovascular diagnosis, the high prevalence of conditions that also require specialist investigations and management are an additional burden on a care pathway that is primarily designed to prevent recurrent stroke. Service commissioners need to assess whether the existing outpatient provision is optimal for people with pathologies other than cerebrovascular disease.

The impact of the ‘Community Refocus Project’ on the Community dietitians service at Western Sussex Hospitals NHS Foundation Trust (WSHFT)

The Chichester community dietetic team offer a domiciliary service for housebound individuals. During 2014 to 2015 total patient contacts increased by 27% without any increase in service funding. The team felt that not all the referrals for dietetic input were appropriate, complete or timely which made prioritisation difficult and impacted on the effective use of clinical resources. This abstract outlines the service improvements undertaken to address the above concerns. A review of referrals received in January and February 2015 showed frequent omission of relevant information and inadequate identification of malnutrition. Most referrals were received from GPs and community nursing teams/allied health professionals. The majority of referrals (61%) were for care home residents. Following assessment 26% of referrals were deemed inappropriate by the Dietitian. From March to July 2015 the dietetic team established the ‘Community Refocus Project’. The community nursing teams and allied health professionals highlighted a lack of awareness of referral criteria, the use of outdated referral forms and patient information literature, a lack of weighing equipment and a perceived lack of effective multidisciplinary working between Dietitian and community staff. The key objectives for the project are shown in Table 1.Table 1Key ObjectivesRevise ‘Malnutrition Universal Screening Tool’ formDevelop community dietetic referral criteria and triage processRevise community dietitian referral formDevelop working links with community healthcare professionalsRevise patient information leafletImplement and evaluate training package Open table in a new tab The local community malnutrition screening tool was revised in consultation with our community healthcare teams and based on guidance from British Association for Parenteral and Enteral Nutrition (BAPEN). Triage criteria for referrals were revised to base prioritisation on the ‘Malnutrition Universal Screening Tool’ score and dysphagia risk. The referral form was updated to reflect information required for appropriate triaging and a standard response letter was developed for incomplete or inappropriate referrals. An information leaflet was developed for healthcare professionals to use with patients requiring first line food fortification advice. GPs and community healthcare teams were informed of the new processes. An education package including a teaching session and resource pack for healthcare professionals was developed covering all aspects of malnutrition management in the community. Training sessions were attended by more than 50 community staff and 100% positive feedback received. All resources developed were made available on the WSHFT public facing website and some were also included in the local CCG Adult Oral Nutritional Supplement Formulary. To date, the team report that the new referral and triage process is more robust and that having up to date resources available is beneficial. This work has also led to improvements in working relationships with community nursing teams and the medicines management team. Initial findings from a repeat review of referrals in January and February 2016 showed that the total number of referrals remained the same and that these continued to be predominately for care home residents (68%). There was a decrease in referrals from community staff from 25% to 11%; however, there was an increase in referrals coming from GPs. These initial findings highlight potential key areas for development, although further evaluation of the project within the wider community is required.

The Use of Psychosocial Services Post Hand and Upper Limb Injury and Trauma: A Pilot Study.

Research demonstrates that hand injuries may cause psychological difficulties. To enhance recovery, therapists must provide appropriate referrals. The purpose of this study was to explore the use of psychosocial services by occupational therapists (OTs) and certified hand therapists (CHTs) post hand and upper limb injury or trauma. A quantitative survey design was implemented using a self-made questionnaire, which consisted of questions regarding demographic information, types and frequency of hand and upper limb injuries, psychiatric diagnoses, frequency of psychosocial service referrals, frames of references used, types of psychosocial assessments and interventions employed, and barriers to psychosocial services. The questionnaire was randomly distributed to 29 therapists. The most frequently recorded frame of reference was the Biomechanical. Only 17.2% participants implemented psychosocial assessments. Sixteen of the 29 participants referred to 9 possible psychosocial services; however, majority of referrals were "occasionally." OTs specialized in mental health, behavioral specialists, and social workers were recorded with the least amount of referrals. A Spearman rank correlation found a weak, but significant inverse relationship between referrals by therapists and years of experience as an OT or CHT (-0.322 and -0.351, P < .05, respectively). Therapists appear to be biomechanically oriented which may impact outcomes. An inverse correlation was found where the less experience participants had, the more likely they were to refer to psychosocial services. The results emphasized the lack of psychosocial assessments, interventions, and referral services being used by therapists. Further education to therapists, third parties, and other health professionals is warranted.

Referral patterns of special needs patients at the Royal Dental Hospital of Melbourne, Victoria, Australia.

Special Needs Dentistry (SND) has been recognized as a dental specialty in Australia since 2003 but there have been no studies addressing the profile of patients for specialist care. The purpose of this study is to identify, via referrals received, the profile of patients and quality of referrals at the largest public SND unit in Victoria, Australia. All referrals received over a 6-month period (1January-30June 2013) by the integrated SND unit (ISNU) were reviewed prior to allocation to the outpatient clinic (OP), domiciliary (DOM) or general anaesthetic (GA) services. Six-hundred and eighty-eight referrals were received with the majority for the OP clinic (68.3%), followed by DOM (22.4%) and GA services (9.3%) (χ2 =360.2, P<0.001). A referral may have specified more than one special needs condition with the most common category being those who were medically compromised (81.7%). The reasons for referral included lack of compliance (27.2%), further management due to multiple medical conditions or GA services required (9.9%), or for multiple other reasons (62.9%). A diverse pattern of SND patients was referred to the ISNU with a majority of referrals having no specific referral reason cited, suggesting poor quality of referrals.

Breast and ovarian cancer referrals to the ACT Genetic Service: are we meeting guidelines?

The ACT Genetic Service at The Canberra Hospital evaluates the genetic risk of individuals for inherited diseases, and provides counselling and genetic testing where appropriate. To evaluate the current referral practice for patients with a personal and/or family history of breast and/or ovarian cancer, and to assess whether these referrals are made according to eviQ cancer referral guidelines. A retrospective clinical audit of patients seen by the ACT Genetic Service for evaluation of genetic risk of breast and/or ovarian cancer between 1 January 2013 and 30 June 2015. Statistical analysis included Chi-squared and Poisson distribution tests. Of the 711 patients referred during the 30-month period, 671 were seen by the service. The number of patients seen increased steadily over the time period, as did waiting times. The majority of referrals were made by general practitioners (403/711; 57%) and oncologists (172/711; 24%). Of note, 300 of 711 (42%) of all referrals made to the service during this time period did not meet eviQ referral guidelines. Patients who met guidelines for referral were more likely both to be offered genetic testing and to have a positive result. Demand on the ACT Genetic Service increased over the time period assessed. As a significant proportion of patients did not meet eviQ cancer referral guidelines, it is worth reviewing the referral process in order to optimise utility of this limited resource.

Increasing efficiency in emergency surgical care

In response to increases in emergency surgical admissions, the Royal College of Surgeons of England (RCSE) published guidelines on ways to separate inpatient emergency and elective surgery with the creation of the surgical assessment unit (SAU). This study aimed to evaluate the impact of a new SAU on acute surgical patient pathways in a busy district general hospital and compare it with the RCSE standard for emergency care. Data were retrospectively extracted from records for all patients attending the SAU over an 8-week period. Patient demographics, methods of referral, rate of discharge, time spent in the SAU, imaging, diagnosis and the requirement for emergency surgical intervention were looked at. During the period studied there were 956 attendees, who spent an average time of 5 hours 48 minutes in the unit. Forty nine percent were admitted and of these, 41% required emergency surgery, with a further 18% of patients (60) re-attending the next day for emergency surgery. A total of 316 radiological investigations were conducted on the SAU patients. The average waiting time for a scan was 5 hours and 3 minutes. The majority of referrals were from GPs (38.5%). The SAU at Watford hospital is meeting the majority of the RCSE's guidelines, however there are several areas in which the unit can continue to improve. With hospitals under increasing pressures, this unit highlights a service where patients can be diverted from A&amp;E to a dedicated assessment area, which is key to the future efficiency of emergency surgical care.

PathWell: The development of a triage center and access hub for comprehensive palliative care in oncology.

162 Background: Routine screening to identify palliative care (PC) needs, followed by assessment and management of needs is critical for high-quality cancer care. Our current healthcare system there is poor screening for PC needs, low referral rates to PC services, and unmet needs. In response to these gaps, we developed a dedicated triage center to streamline the assessment of PC needs and better connect patients with appropriate supportive care services. Methods: We identified 24 services at our academic cancer center that provide PC and supportive services. Examples include PC, psycho-oncology, survivorship, nutrition, and social work. Representatives from these groups convened to map service overlap and develop referral structures based on patient need and acuity. A triage hub (PathWell) was established to complete uniform assessments of patient needs and determine appropriate referrals. The hub utilized a centralized scheduling platform, new patient coordinators, and an oncology nurse for assessment and triage. Referrals to the hub were made via EHR, direct patient contact, or prompted by routine distress screening. Results: PathWell launched on February 1, 2016. Referral volume to the hub was 54 in February, 91 in March and 74 in April. Referrals from PathWell were distributed amongst the 24 services, the majority of referrals going to PC, psycho-oncology and nutrition. All programs that were part of the triage center experienced growth in volume; PC 41%, psycho-oncology 14%, nutrition 16%. Conclusions: Partnerships between specialist services and dedicated triage staff can improve early access to resources for PC needs. Early data from PathWell reveals improved assessment and management of patient needs via referrals to appropriate services. The hub has also unveiled important resource gaps (e.g. physical therapy, integrative medicine). These gaps were not previously quantified, and thus not prioritized by leadership. Future state for PathWell includes reporting operational and health-related outcomes, optimizing distress screening, establishing care pathways for patient subtypes (e.g., metastatic disease), and hosting interdisciplinary tumor boards for complex distress management.

An exploration of the potential utility of fetal cardiovascular MRI as an adjunct to fetal echocardiography.

ObjectivesFetal cardiovascular magnetic resonance imaging (MRI) offers a potential alternative to echocardiography, although in practice, its use has been limited. We sought to explore the need for additional imaging in a tertiary fetal cardiology unit and the usefulness of standard MRI sequences.MethodsCases where the diagnosis was not fully resolved using echocardiography were referred for MRI. Following a three‐plane localiser, fetal movement was assessed with a balanced steady‐state free precession (bSSFP) cine. Single‐shot fast spin echo and bSSFP sequences were used for diagnostic imaging.ResultsTwenty‐two fetal cardiac MRIs were performed over 12 months, at mean gestation of 32 weeks (26–38 weeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (n = 10) and pulmonary vessels (n = 4). Single‐shot fast spin echo sequences produced ‘black‐blood’ images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Real‐time SSFP allowed for dynamic assessment of structures such as cardiac masses, with enhancement patterns also allowing for tissue characterisation in these cases.ConclusionsFetal vascular abnormalities such as coarctation can be difficult to diagnose by using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

Caring About Residents' Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home.

To describe the CARES program, a model of palliative care for nursing home residents. Descriptive analysis of the Caring About Residents' Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.

Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform

Objectives: Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. Methods: During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Results: Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. Conclusion: The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.

Refining the use of an electronic medical record (EMR) to define and implement psychosocial distress screening and treatment.

144 Background: All cancer patients experience some level of distress associated with cancer and its treatment at all stages of the disease. Psychological and social problems created or exacerbated by cancer cause additional suffering, weaken adherence to prescribed treatments and threaten patients' return to health." Health care providers often tend to under estimate psychological distress. Screening and early identification of distress promote improved management of symptoms, which facilitates medical care. Psychosocial care must be integrated into the routine treatment of cancer patients, per the Institute of Medicine's 2008 report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs." Methods: Developing operational standards for Distress Screening our cancer center both NCCN guideline, Commission on Cancer Standards. These operational standards integrated our Electronic Medical Record to create "best practice advisories" to alert the physician to the possible need for further evaluation of distress and the possible need for referral to Social Work staff or the on-site Psychologist. Results: Referrals to our on-site staff Psychologist at our main campus were monitored. 306 unique patients were referred to our staff psychologist for evaluation and treatment during the 2014 calendar year. In the first three quarters of the 2015 a total of 445 were made. Surgical oncology clinics (Head &amp; Neck, Breast &amp; Upper Gastro-Intestinal) made the majority of referrals. Conclusions: In accordance with published guidelines and accrediting standards our cancer center utilized our electronic medical record to increase our ability to identify psychosocial distress in our population.

Abstract WP324: Integrated Systems Enhance Equitable and High-Quality Stroke Prevention Clinic Care

Stroke prevention clinics were established in Ontario to provide comprehensive, equitable, evidence-based care for patients at high risk of stroke. However, depending on where patients present with their stroke symptoms there are differences in access to diagnostic services. Patients presenting to a primary care office or small hospital, have limited or no access to diagnostic services compared to those presenting to large academic hospitals. To overcome this inequitable access to stroke expertise and diagnostics, we developed a standard referral protocol, a centralized approach to triage and dedicated diagnostic imaging services in regional stroke prevention clinics. The objective of our research was to evaluate the degree to which these system supports have resulted in comprehensive stroke prevention best practice care. Retrospective data analysis was completed using the FY 2011/12 Ontario Stroke Audit of Secondary Stroke Prevention Clinics database. We examined differences in secondary stroke prevention best practices across the five stroke prevention clinics and if there were differences in practice by referral source (Emergency vs. Primary Care). A total of 1853 patients were seen at the five Champlain stroke prevention clinics in 2011/12. The majority of referrals were initiated from Emergency Departments 58.7%, followed by primary care 29.2%, specialists 9.2% and inpatient units 2.8%. Overall, high rates of neuroimaging (97.6%), and vascular imaging (97.6 %) were achieved with little variation across stroke prevention clinics. There was no variation in imaging rates by referral source. The stroke prevention clinics facilitated neuroimaging and vascular imaging for almost 30% of patients, as they did not have these tests completed at the site of initial presentation. Implementing a centralized stroke prevention clinic referral and triage system has enabled equitable access to essential diagnostic testing in the Champlain region. Rapid diagnostic imaging plays a vital role of in identifying stroke etiology, and influences patient prioritization, treatments and management in the stroke prevention clinic setting. Future research should include evaluation of patient outcomes relative to the timing of diagnostic testing.

Analysis of referrals and triage patterns in a South African metropolitan adult intensive care service.

Intensive care unit (ICU) beds are scarce resources in low- and middle-income countries. Currently there is little literature that quantifies the extent of the demand placed on these resources or examines their allocation. To analyse the number and nature of referrals to ICUs in the Pietermaritzburg metropolitan area, South Africa, over a 1-year period, to observe the triage process involved in selecting patients for admission. A retrospective review of the patients referred to ICUs at Grey's and Edendale hospitals, Pietermaritzburg, was performed over a year. The spectrum of patients was evaluated with respect to various demographics, and the current triage process was observed. The Pietermaritzburg Metropolitan Critical Care service (PMCCS) received 2,081 patient referrals, 53.4% (1,111/2,081) of males and 46.6% (970/2,081) of females, with a mean patient age of 32 years. The majority of referrals were of surgical patients (39.3%, 818/2 081), followed by medical (18.9%, 393/2,081), trauma (18.6%, 387/2,081) and obstetrics and gynaecology (11.7%, 244/2,081). The chief indications for referral were the need for cardiovascular and respiratory support. Of these referrals, 72.0% (1,499/2,081) were accepted and planned for admission and 28.0% (582/2,081) were refused ICU care. Of the patients accepted, 60.7% (910/1,499) experienced delays prior to admission and 37.4% (561/1 499) were never physically admitted to the units. The PMCCS receives a far greater number of patient referrals than it is able to accommodate, necessitating triage. Patient demographics reflect a young patient population referred with chiefly surgical pathology needing physiological support.

G468(P) The majority of referrals from gp to general paediatric outpatient clinic could be managed by alternative methods

Aims Audit 100 referrals made to a hospital general paediatric outpatient clinic from General Practice to assess (i) Appropriateness (ii) Possible alternative methods of management Implement alternative and innovative methods of management using a multi-professional approach Improve quality of care for patients Methods Using a proforma, each referral was assessed by 3 people: A Paediatrician (taken from a pool of 3 Consultants), A GP physician (taken from a pool of 2) and A Paediatric nurse specialist Results 76–97% of patients seen in paediatric general outpatients could have been managed with at least one alternative method. The range reflects variation in assessor’s opinions (Figure 1 and Table 1). Conclusions The majority of cases seen in general paediatric outpatients in this sample did not require secondary care. Importantly, this study suggests that, with the support and partnership of secondary care, General Practice has the potential to be able to provide a safe, more rapidly accessible and cost-effective paediatric service than that currently being offered at the level of a general paediatric outpatient clinic. In terms of our progress: (i) Telephone hotline will be rolled out shortly (ii) Rapid access clinic opens in April 2015 (ii) Roll out of Community nurses (multi-professional approach) (iii) Development of email service and virtual clinic (iv) Increased support for GPs

Bone density assessment in a tertiary paediatric centre over 13 years: Referral patterns and limitations.

This study aims to examine the referral practices for the Royal Children's Hospital (RCH) bone density service over the past 13 years and to demonstrate referral patterns and possible limitations to accessing paediatric bone densitometry. All patients attending the RCH Healthy Bones Unit for bone densitometry from 1 July 1999 to 30 June 2012, aged under 18 years of age, were included. Densitometry results were downloaded directly from the Hologic scanner into an Excel document. However, the referring unit and indication for referral were collected manually from either the referral card or the hospital's scanned medical records system. A total of 5767 bone densitometry scans were performed over the study period on 3004 patients. The majority of referrals were made by the Endocrinology department, followed by Adolescent Medicine, Gastroenterology and Neurology. Relatively few referrals were made by general paediatrics. The most common indication for bone density test overall was eating disorders, followed by steroid use, osteogenesis imperfecta and other collagen disorders and inflammatory bowel disease. The lowest lumbar spine z-scores by indication were for cerebral palsy and other causes of immobility. Multiple childhood diseases predispose to low bone density; however, paediatric bone densitometry is still underutilised and not appropriately supported by subsidies.