Type Of Referral Research Articles

1295 Virtual Fracture Clinic: An Audit of Referral Quality and Service Effectiveness

Abstract Aim Assessment of referral quality to the virtual fracture clinic (VFC) at the Liverpool University Hospital foundation trust compared to the standards set out by the Glasgow virtual fracture clinic pathway. As a secondary aim the effectiveness of the VFC in diverting patients not requiring further clinical management away from face-to-face specialist physical fracture clinics (PFC) was assessed. Method Outcomes of 1st attendances were collected for standard PFC's before the implementation of the VFC at our centre. This data was comparatively analysed to the outcomes of 1st ‘attendances' of VFCs post-service implementation. To assess VFC referral quality fracture type was recorded and compared to the standard set out by the Glasgow virtual fracture pathway which states that a selection of simple stable fractures should be discharged from ED directly with patient advice and telephone support. Results We analysed 529 PFC first attendances and 402 VFC first attendances. We saw a variety of simples stable fractures (21%) in the VCF including: Distal radial, Fifth metatarsal, Minor radial head, Fifth metacarpal, Mallet finger, which could have been managed with direct ED discharge and telephone support. 19.4% of PFC attendance resulted in discharge without a change in management as compared to 22.1% of 1st attendances for the VFC. Conclusions The VFC clinic has shown itself as an effective service in re-directing patients from face-to-face appointments, evidenced by the comparative rates of patient discharge on first attendance. This study has laid the foundation for improving referral quality to the VFC. Collaborative efforts between Orthopaedics and ED could improve VFC clinic efficiency further.

Effectiveness of telemedicine in response to the COVID-19 pandemic.

The aim of this study was to evaluate the utility of the telemedicine care model implemented to treat and guide patients with COVID-19 related symptoms and indicators during the pandemic. This is a retrospective study with data collected from the electronic records of standardized forms for assistance. As a way of evaluating the work performed, the number of consultations, types of referrals, efficiency of care, and patient satisfaction were observed. Between April 2 and October 15, 2020, 92 professionals attended 3,660 patients by telemedicine; out of them, 523 (14.3%) were referred to a COVID-19 attending room, 128 (3.5%) to other specialties, 123 (3.4%) to a general emergency department, and 2,886 (78.9%) were monitored via home care. Of the total number of patients, 81 (2.2%) were hospitalized, and 13 (0.35%) died. Telemedicine offered useful tools for the care, treatment, and monitoring of patients with COVID-19 during the pandemic. The service was considered by most respondents as satisfactory, resolutive, or safe.

The important role of Type A Hospital in efforts to reduce the covid-19 cluster by improving the dimension of service quality in building satisfaction and loyalty of covid-19 patients in Surabaya

COVID-19 in Surabaya has reached 20,832 cases. Of these, 19,270 people have recovered, and 1,313 people have died and 249 people are being treated on the Surabaya COVID-19 Response website. In addition, the Surabaya City Government is also still working continuously in the vaccination process which until now recorded 34,869 people have been vaccinated in the first stage. Therefore, this study was conducted to know the development of health services hospital type A referral COVID-19 in Surabaya. The purpose of this study is to evaluate and analyze behavioral intentions of COVID-19 survivors at COVID-19 referral type A hospitals in Surabaya. Based on the purpose of the study, the expected benefit of this study is to increase knowledge in the field of management, in this case related to variables Technical Quality, Infrastructural Quality, Interactional Quality, Personnel Quality, Social Support Quality, Patient Satisfaction, and Behavioral Intention. This research is a causal study with quantitative research methods. The data analysis process uses the process of validity test analysis, reliability test, classical assumption test using SPSS 22.0 software. The data collection in this study was conducted by spreading questionnaires through google form to more than 140 respondents with characteristics who areCOVID-19 survivors at COVID-19 referral type A Hospital in Surabaya.

Appointment Service Centres for Specialist Medical Appointments: How Effective are they?

To reduce outpatient specialist waiting times and to help patients with statutory health insurance to get appointments and urgent referrals within four weeks, phone appointment service centres (ASC) were introduced in Germany in January 2016. The aim of this study was to analyse these booking patterns in the Westphalia-Lippe (WL) region, and to compare the types of regular specialist referrals with those made by the centers. Furthermore, neurology services to patients with ASC referrals were compared to those without. Appointment data from the second quarter of 2016 to the third quarter of 2019 were used, and an algorithm was developed to determine the range of services provided in appointments made by the ASCs. A total of 24,286,157 accounting slips were compared with 12,648 specialist service records from the Association of Statutory Health Insurance Physicians in the WL region. The average waiting time for an appointment with a specialist was 21 days for 84% of the callers with a referral (aged mostly 35-59 years). Requests for appointments with neurologists, internists, and radiologists were the most frequent ones; 45% of service centre specialist appointments were made with neurologists, despite these comprising only 4% of total referrals in WL. There were only a few differences in the use of services in neurologist appointments with and without the mediation of the ASC. The higher level of ASC used for making neurologist appointments for initial psychotherapeutic assessment was statistically significant. However, the effect was small. Despite its relatively low use (0.19% of specialist referrals in general), ASCs in the WL region are able to make urgent specialist appointments for patients with statutory insurance, with average waiting times significantly lower than the legally set maximum waiting period. However, patients also take other factors into account when making appointments. While the benefits of these centres, especially for three types of specialists, was demonstrated, further discussion on the form of the ASCs in their current form is warranted. This paper provides a basis for evaluation of methodology and content for further decision-making.

Understanding health disparities affecting utilization of tobacco treatment in low-income patients in an urban health center in Southern California

Tobacco use disproportionately affects low-income communities. Prevalence among patients in Federally Qualified Health Centers (FQHCs) is higher (29.3%) than the general population (20%). Little is known about the rates of referrals to cessation services and cessation pharmacotherapy practices in FQHCs. This study will examine referral and prescribing patterns based on patient characteristics at a large FQHC in Southern California. We conducted a retrospective analysis of EHR data from 2019. Patients who were ≥ 18 years old and had “tobacco use” as an active problem were included in analyses. We characterized the proportion of 1) those who were referred to California Smokers’ Helpline (CSH), 2) referred to smoking cessation counseling (SCC) at the FQHC clinic, or 3) received pharmacotherapy. Associations of demographic characteristics and comorbidities with referral types and uptake of services were evaluated using mixed-effects multinomial and logistic regressions. Of the 20,119 tobacco users identified, 87% had some cessation intervention: 66% were advised to quit and given information to contact CSH, while 21% were referred to SCC. Patients were least likely to get referred to cessation services if they had more medical, psychiatric, or substance use comorbidities, were in the lowest income group, were uninsured or were Hispanic. Although EHR systems have enhanced the ease of screening, most patients do not receive more than brief advice to quit during a PCP visit. Most (70%) low-income smokers see their PCPs at least once a year, making FQHCs excellent settings to promote smoking cessation initiatives in low-income populations.

Developing a clinical psychology service for patients affected by Covid-19: Reflections from Leeds Department of Clinical and Health Psychology

The paper discusses a new clinical psychology service developed during the first Covid-19 pandemic to offer psychological assessment and intervention to patients diagnosed with Covid-19. Information about the type of referrals and interventions offered were collected. Reflections of the service were captured from a patient and therapist perspective.

PD03-07 EVALUATING MEDICAID UROLOGIC REFERRAL PATTERNS VIA ECONSULT IN A DIVERSE NON-INTEGRATED NETWORK OF COMMUNITY-BASED HEALTH SYSTEMS

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (PD03)1 Sep 2021PD03-07 EVALUATING MEDICAID UROLOGIC REFERRAL PATTERNS VIA ECONSULT IN A DIVERSE NON-INTEGRATED NETWORK OF COMMUNITY-BASED HEALTH SYSTEMS Desiree Sanchez, Alvin Kwong, Waheed Baqai, Sajid Ahmed, and Stanley Frencher Desiree SanchezDesiree Sanchez More articles by this author , Alvin KwongAlvin Kwong More articles by this author , Waheed BaqaiWaheed Baqai More articles by this author , Sajid AhmedSajid Ahmed More articles by this author , and Stanley FrencherStanley Frencher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001967.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most patients in the US receive urologic care in their local communities; yet, the majority of published urologic patient data is derived from academic/academic-affiliated centers or large registries. This is problematic given the lack of racially diverse and underserved populations within academic cohorts, and inability to access granular data within registries. Telemedicine services like electronic consultation (eConsult), an electronic, asynchronous provider-specialist consultation system, are now used across various health systems including California’s largest Medicaid network, the Inland Empire Health Plan (IEHP). The IEHP mandates eConsult use for all specialty referrals for its 1.2 million patients. Here, we present the largest analysis of eConsult use in urology and characterize referral patterns in the safety net from a diverse non-integrated network of community-based health systems across Southern California communities. METHODS: We retrospectively reviewed all patients referred via eConsult from 2018-2020. Our main objective was to perform a descriptive analysis of all urologic eConsults within the IEHP since inception of the program. We categorized consult type etiology and measured the final eConsult outcome recommendation (e.g., face-to-face referral, no further action etc). To assess efficiency we measured message count, urologist response time and time to eConsult close. RESULTS: From 5/2018-8/2020, 1205 patients were referred for urologic eConsult. Median age was 53 (IQR 39, 61). Most patients were male (60%). BPH and/or LUTS or Retention and Gender-confirming surgery were the most and least common referral types, respectively (Figure 1). Majority of eConsults resulted in face-to-face recommendation (75%). Median total message count was 2 (IQR 2,3). Urologists responded within 0.4 days (IQR 0.1, 1.2) and spent <5 min to complete an eConsult; eConsults were closed in <1.5 days (IQR 0.3, 8.1). CONCLUSIONS: We report the largest analysis of eConsult use in urology. Its use allows for timely, efficient urologic access in the IEHP and presents a means to assess urologic needs in the community. We had a high rate of in-person conversion suggesting the need to study eConsult implementation and optimization strategies. Source of Funding: HH Lee Research Grant. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e45-e45 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Desiree Sanchez More articles by this author Alvin Kwong More articles by this author Waheed Baqai More articles by this author Sajid Ahmed More articles by this author Stanley Frencher More articles by this author Expand All Advertisement Loading ...

Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: A retrospective cohort study

IntroductionTuberculosis (TB) is the global leading cause of death from an infectious agent. Tanzania is among the 30 high TB burden countries with a mortality rate of 47 per 100,000 population and a case fatality of 4%. This study assessed mortality rate, survival probabilities, and factors associated with death among adult TB patients on TB treatment in Tanzania. MethodsA retrospective cohort study was conducted utilizing case-based national TB program data of adult (≥15 years) TB cases enrolled on TB treatment from January 2017 to December 2017. We determined survival probabilities using the Kaplan-Meier estimator and a Cox proportional hazard model was used to identify independent risk factors of TB mortality. Hazard ratios and their respective 95% confidence intervals were reported. ResultsOf 53,753 adult TB patients, 1927 (3.6%) died during TB treatment and the crude mortality rate was 6.31 per 1000 person-months. Male accounted for 33,297 (61.9%) of the study population and the median (interquartile range [IQR]) age was 40 (30–53) years. More than half 1027 (56.7%) of deaths occurred in first two months of treatment. Overall survival probabilities were 96%, and 92% at 6th and 12th month respectively. The independent risk factors for TB mortality among TB patients included: advanced age ≥ 45 years (adjusted hazard ratio (aHR) = 1.74, 95% confidence interval (CI) = 1.45–2.08); receiving service at the hospital level (aHR = 1.22, 95% CI = 1.09–1.36); TB/HIV co-infection (aHR = 2.51, 95% CI = 2.26–2.79); facility-based direct observed therapy (DOT) option (aHR = 2.23, 95% CI = 1.95–2.72); having bacteriological unconfirmed TB results (aHR = 1.58, 95% CI = 1.42–1.76); and other referral type (aHR = 1.44, 95% CI = 1.16–1.78). ConclusionAdvanced age, TB/HIV co-infection, bacteriological unconfirmed TB results, other referral types, receiving service at facility-based DOT option and obtaining service at the hospital level were significant contributors to TB death in Tanzania. Appropriate targeted intervention to improve TB referral systems, improve diagnostic capacity in the primary health facilities, minimize delay and misdiagnosis of TB patients might reduce TB mortality.

Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation

Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.

The efficiency of the medical role within a Single Point of Access (SPA) Service in reducing the number of clinic appointments required

AimsThe SPA service takes referrals from general practitioners (GPs), medical professionals, the London Ambulance service, the London Police, psychology and social services, and from patients themselves and their family members or support groups. Some of these referrals require input from secondary care, but others can be solved within primary care if given specialist advice, this minimizing the time spent by patients in the healthcare system and minimizing also the NHS costs.Our aim was to evaluate the implementation of the Advice from Medics Service in a 1-year period.MethodWe examined a random sample of 200 referrals between 1st of April 2019 and 31st of March 2020 out of all referrals that were considered, after the triage, to be appropriate for an advice on treatment provided by the medics as an alternative to a clinic appointment in secondary care. We collected information from the electronic patient records regarding the dates of referrals, the senders of referrals, the type of referrals, the age and gender of patients and the reasons to be referred, and finally we analysed the outcome of the referrals and compared it with the action requested.ResultOf the 200 referrals, 113 were for female patients and 87 for male patients. The age of patients was between 18 and 91 years old, with a median of 43 years old.The person/authority making the referral was the GP in 179 cases, and others in 21 cases.The referrers asked for review in 74 cases, urgent review in 2 cases, review and advice in 31 cases, only advice in 46 cases, and did not state the type of referral in 47 cases.The primary pathology implied was affective in most of the cases (122), followed by psychotic (31) and neurotic (22), organic (8), of personality (5), hyperkinetic disorders (5), due to substance misuse (4), of psychological development (2) and learning disability (1).The outcome of the referrals was as follows: 19 patients (9.5%) were seen by the Crisis Team, 11 (5.5%) were referred to other teams, 4 (2%) did not engage with SPA, and the rest of 166 (83%) referrals were solved with advice.ConclusionThe outcome was extremely favourable as the majority of referrals requested medical review but most of them (83%) were solved with specialist advice to GPs or other professionals, highlighting that the implementation of the Advice from Medics Service has been an improvement to the SPA.

464-P: Does the Referral Source Influence Retention in Community Diabetes Prevention Programs

The Montana Diabetes Prevention Program (DPP), with over 20 community sites, has tracked participants in a statewide registry since the inception of the program in 2008. Montana’s DPP sites conduct the standard lifestyle intervention in the fall and the spring of each year, recruiting group participants who have been referred from the surrounding community. Because retention in the program is key for success, we used data from the registry to ascertain if the referral source influenced the hazard of dropout among DPP participants. From the 2015 fall cohort through the fall cohort of 2019, 3,030 participants were eligible for analyses and referral information was available for 75.2% (2,280). The three primary referral methods were: physician referral (n=914), referral by a former DPP participant (n=422), and referral by a friend or family member (n=393). We conducted a survival analysis using the last DPP session attended as a measure for dropout. Backwards selection was used to identify significant covariates for inclusion in the adjusted model. A significant difference in time to dropout by type of referral was observed (p=0.0045). When compared to participants referred by a friend or family member and after adjusting for age, income, and distance traveled, the hazard of dropout was 17.4% higher for participants who were referred by a physician (HR: 1.174, 95% CI: 1.014, 1.395, p=0.0321) and 26.5% higher for participants who were referred by a former DPP participant (HR: 1.265, 95% CI: 1.057, 1.513, p=0.0103). These findings suggest that enlisting support from friends and family members may be helpful in retaining participants referred by physicians or former DPP participants. Disclosure H. Koeppen: None. S. Tysk: None. M. House: None. J. Fernandes: None. T. S. Harwell: None. S. D. Helgerson: None. D. M. Gohdes: None. Funding Centers for Disease Control and Prevention (NU58DP006517)

The impact of the COVID-19 pandemic on referrals to liaison psychiatry services at University Hospital Hairmyres, NHS Lanarkshire

AimsThe COVID-19 pandemic has led to sweeping public health restrictions with predictable impact on mental health. In Scotland, lockdown measures during the first wave of the pandemic commenced on 23rd March 2020 and only began to ease after 29th May 2020. The aim of this study was to evaluate the impact of the first wave of the COVID-19 pandemic on the number and type of referrals made to the adult psychiatric liaison nursing service (PLNS) at University Hospital Hairmyres, NHS Lanarkshire.MethodWe collated all of the archived referrals made by our local emergency department to the PLNS at University Hospital Hairmyres for adults (aged 18–65 years) during the period of the first COVID-19 national lockdown (April-July 2020) and the corresponding period one-year prior (April-July 2019) to analyse differences in referral numbers and demographics. Additionally, for referrals made during 2020, we conducted a qualitative review of electronic records to determine the reason for referral, contributory stressors to presentation, and in particular any effect from COVID-19.ResultA total of 549 referrals were made over the study period, with 320 in 2019 and 229 in 2020, a decrease of almost 30%. In 2019, referrals fell each month from April (n = 89) to July (n = 74), while this trend was reversed in 2020, rising from April (n = 45) to near-usual levels by July (n = 68). Compared to baseline, referrals in April 2020 were for a higher proportion of men (62.2%). On qualitative analysis, 26 records (11.3%) could not be found. Otherwise, the most common reasons for referral were suicidal ideation (43.3%) and/or deliberate self-harm (39.9%). Many patients presented with comorbid substance misuse (54.2%) and the majority were not known to community services (64.5%). COVID-19 was implicated in 48 referrals (23.6%), but only 2 of these arose as a direct result of infection.ConclusionWe have observed clear differences in the pattern of referrals made to the adult PLNS during the first COVID-19 national lockdown. COVID-19 was implicated in a minority of referrals, but most were related to secondary effects of lockdown restrictions rather than COVID-19 infection. Possible reasons for fewer referrals during this time could be non-presentation through fears of contracting COVID-19 or altruistic avoidance of putting “pressure on the NHS”. Further studies would be insightful; in particular, equivalent analysis of contacts with community services; and qualitative patient perspectives regarding reasons for non-presentation during this time.

Addressing Emotional Wellness During the COVID-19 Pandemic: the Role of Promotores in Delivering Integrated Mental Health Care and Social Services.

IntroductionThe disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress. We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response.MethodsWe used tracking sheets to identify 1,436 unique participants (aged 5–86) enrolled in Latino Health Access’s Emotional Wellness program, of whom 346 enrolled in the pre–COVID-19 period (March 2019–February 2020) and 1,090 in the COVID-19 period (March–June 2020). Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson 𝜒2 tests. Regression models were developed to compare factors associated with referrals in the pre–COVID-19 and COVID-19 periods.ResultsDuring the pandemic, service volume (P < .001) and participant volume (P < .001) increased significantly compared with the prepandemic period. Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic. Nonreferred services, such as peer support, increased during the pandemic period. Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income.ConclusionAn effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities. This study presents a model of how to integrate both factors by leveraging promotor-led programs.

Examination of a distress screening intervention for rural cancer survivors reveals low uptake of psychosocial referrals.

PurposeTo determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns.MethodsWe used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group (N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List.ResultsOverall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted.ConclusionsA nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted.Implications for Cancer SurvivorsScreening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01052-4.

499 Upper GI Surgical Clinic Referrals, Can We Improve Patient Experience?

IntroductionWith increasing pressure on NHS to deal with long waiting lists, solutions to reduce waiting times are imperative. In the era of the COVID-19 pandemic, we need to reshape the way we look into Outpatient clinic appointments.AimTo review all clinic referrals to UGI surgical clinic and highlight any potential pathways that can improve waiting times and patient experience.MethodPatients referred to UGI clinic over 2 months were collected from Iclip, EPR and EDM. Post-discharge appointments and DNA’s were excluded. Data collected included time from referral to clinic, type of referral, symptoms, investigations, potential pathway, first clinic outcome, and appropriateness of referral.ResultsTotal of 147 referrals analyzed. Time from referral to clinic appointment is 51 days. GP referrals represented 73% while the rest from consultant colleagues. The most common symptoms were biliary colic and GORD. OGD and PH manometry were the most common investigations requested. The most common first outcome was pre investigate and clinic follow up. Two potential pathways identified are Biliary colic and GORD pathway. 90% of referrals were appropriate.ConclusionsBiliary colic pathway and GORD pathway are 2 potential pathways that can cut off waiting times for clinic appointments and improve patient experience in outpatient clinics.

Factors associated with diagnostic delay in children with Wilms’ tumor

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty. Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment. Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA. Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain). Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.

A retrospective review of specialist referrals for refugees into Greece's health system: A humanitarian organization's perspective.

ABSTRACTAim:Refugee arrivals to Europe have numbered more than one million since 2015 with the majority arriving through Greece. The healthcare needs of refugees have placed strains on Greece’s healthcare system which has already been affected by its ongoing economic crisis. At the peak of arrivals during 2016, primary healthcare was primarily provided by humanitarian organizations with specialist referrals into the Greek healthcare system. There is little published literature on the type and impacts of specialist referrals for refugees in Greece. The aim of this retrospective review is to identify the type and impacts of specialist referrals for refugees into Greece’s health system.Methods:This retrospective study reviewed the number and type of specialty referrals from one humanitarian organization providing primary healthcare for refugees in Greece. All consultations during an 8-month period (December 1, 2016–July 31, 2017) were reviewed.Results:Of 4168 consultations, 42% were patients aged 17 years or younger, 52% were male, and 90% were Syrian. Two hundred and thirty-three patients (11%) required a specialist referral; 25% were for dental (provided by another humanitarian organization), 10% each for obstetrics and gynecology and pediatrics, and 8% for ophthalmology. Respiratory complaints were most frequently seen, and these were more predominant in the winter months. Pediatric consultations varied according to month, likely due to population movements.Conclusion:Dentistry was noted to be a gap in humanitarian response programming and accounted for the greatest need for specialist input with referrals for women and children accounting for a large proportion of referrals.

Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic

Identifying and treating late dysfunction in survivors of head and neck cancer (HNC) is important; however, an effective way to do so is not established. A quality improvement initiative altering our HNC survivorship clinic to include surveillance by rehabilitation providers was undertaken. The nature of dysfunction identified, along with the number and type of referrals to ancillary/support services were collected and compared to baseline. The baseline, single-provider, clinic evaluated 61 patients and referred 2 (3%) to ancillary/support services. Fifty-seven patients were evaluated in the interdisciplinary clinic, with 36 (63%) referred to at least one ancillary/support service for new/progressive dysfunction. Of 59 referrals made, 22 (37%) were for dysphagia, 17(29%) were for neck/shoulder dysfunction, and 28 (47%) were attended by the patient. Many HNC survivors exhibit late dysfunction appropriate for referral to ancillary/support services. A survivorship clinic including surveillance by rehabilitation specialists may optimize identification of dysfunction.

Interhospital referral of colorectal cancer patients: a Dutch population-based study

PurposeInterhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals.MethodsData were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital.ResultsIn total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT.ConclusionA large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery.

BackgroundEmergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed.ObjectiveTo explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery.MethodsAn observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix.ResultsPatients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]).ConclusionThis study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.