Urgent Referral Research Articles

Corneal ulcers in general practice.

Patients frequently present to general practitioners (GPs) with discomfort and a red eye due to corneal ulceration, defined as a defect in the corneal epithelium and underlying stroma. A myriad of conditions may lead to corneal ulcers, and prompt diagnosis and adequate management isneeded to prevent visual morbidity. The aim of this article is to assist clinicians/GPs to 1) determine the likelycause of a corneal ulcer and 2)understand the management of corneal ulcers, including the timing ofreferral toan ophthalmologist. Corneal ulcers are typically painful and reduce vision. A good understanding of the clinical presentation of corneal ulcers can aid diagnosis and guide treatment. Urgent referral of trauma and infectious keratitis to an ophthalmologist can prevent endophthalmitis and loss of vision and/or the eye. GPs can play an important part in timely referral, in some cases initiating oral antiviral treatment, and by educating patients on preventive measures, especially contact lens hygiene.

285 DEVELOPING A FRAILTY CARE PATHWAY IN A REHABILITATION HOSPITAL: A PILOT STUDY

Abstract Background Frailty is a common condition in older adults. The Clinical Frailty Scale (CFS) is a widely used frailty screening-tool within the Irish healthcare system due to its time-efficiency and transferability between settings. The Edmonton Frailty Scale (EFS) is heralded as an effective tool capturing multi-dimensional aspects of frailty. Due to the lack of blanket referral system for some Multi-Disciplinary Team (MDT) members in our Irish rehabilitation hospital, early identification of frailty is key to ensure timely input from all disciplines. To optimise MDT intervention, the EFS was piloted alongside the CFS comparing user-experience and sensitivity. Methods Education sessions were held by frailty-group members to familiarise staff with frailty concepts and frailty-tool administration. The EFS and CFS were administered with all patients over 65 years within 72 hours of admission onto two wards of our hospital over a three-month period. Frailty scale completion was co-ordinated by the physiotherapists and occupational therapists who operate a blanket referral system. Detection of frailty triggered an urgent referral to dietician, medical social work and speech and language therapy colleagues who don’t operate a blanket referral system. The target time for MDT input was two days for the severely frail cohort and one week for mild or moderately frail patients. Results The EFS was administered for 83 patients (mean age: 84 years). Of those, 6% were severely frail, 23% were moderately frail and 28% were mildly frail. The CFS was found to detect a higher frailty level in 47% of patients screened when compared to the EFS and took an average of ten minutes less to administer. Conclusion The CFS will continue to be administered with patients due to its higher sensitivity to frailty and time efficiency for completion. Referrals will continue to be generated to all MDT members to expedite input with frail patients.

295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS

Abstract Background Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology. Methods The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system. Results Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions. Conclusion Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.

Outcomes of Vitreoretinal Complications Requiring Operation after Abusive Head Trauma.

Abusive head trauma (AHT) can result in retinal complications that require operative intervention. There is no review evaluating the outcomes of vitreoretinal operations in aggregate or on the timing of vitreoretinal intervention. This systematic review aims to fill this knowledge gap. A literature search between 2011 and 2021 was performed with PubMed, Web of Science, and Embase. Included articles described outcomes of vitreoretinal operations after AHT either in aggregate or as individual cases. Nine articles met criteria; the direct outcomes of operations were collected to minimize bias. Visual acuity (VA) and anatomic outcomes were compared between patients who received operations within 4 weeks of diagnosis and those who had delayed intervention. This review found that vitreoretinal surgery after AHT has excellent anatomical success rates, but there is a trend toward improved VA outcomes when performed within 4 weeks of diagnosis. This highlights the importance of urgent referral to a pediatric retina surgeon for non-clearing vitreous hemorrhage, retinal detachment, and retinal tears after AHT.

RADIOGRAPHIC FINDINGS OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

RADIOGRAPHIC FINDINGS OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

The Integration of Diabetic Eye Screening into Hemodialysis Units in Northern Ireland.

Diabetes is rising globally and is the most common cause of both end-stage renal disease and blindness. People on hemodialysis have to attend several dialysis appointments per week, which can affect their attendance at diabetic eye screening. In addition, previous literature suggests patients on hemodialysis are more likely to have sight-threatening diabetic eye disease. This study aims to determine attendance at the Diabetic Eye Screening Program in Northern Ireland, diabetic retinopathy severity, and use of handheld retinal imaging in people with diabetes attending hemodialysis units in Northern Ireland. All patients with diabetes attending hemodialysis clinics regionally were screened and graded by the Diabetic Eye Screening Program in Northern Ireland using a handheld and/or conventional nonmydriatic fundus camera. All eligible people (N=149) were offered a Diabetic Eye Screening Program in Northern Ireland appointment, 132 attended, 34% of whom had not been seen in >3 years and 15% of whom had never attended the Diabetic Eye Screening Program in Northern Ireland despite multiple previous appointments. Altogether, 13% required urgent referral to hospital eye services, which is significantly higher than the national average of 0.4%. Those on hemodialysis are at high risk for sight-threatening diabetic retinopathy. Implementing the Diabetic Eye Screening Program in Northern Ireland in hemodialysis clinics enables timely diagnosis and referral.

Neuroimaging in the Acute Psychiatric Setting: Associations With Neuropsychiatric Risk Factors.

The appropriateness and clinical utility of neuroimaging in psychiatric populations has been long debated, and the ambiguity of guideline recommendations is well established. Most of the literature is focused on first-episode psychosis. The investigators aimed to review ordering practices and identify risk factors associated with neuroradiological MRI abnormalities and their clinical utility in a general psychiatric population. A retrospective file review was undertaken for 100 consecutive brain MRI scans for adult psychiatric inpatients who received scanning as part of their clinical care in an Australian hospital. Brain MRI was abnormal in 79.0% of scans; in these cases, 72.2% of patients required further investigation or follow-up, with 17.7% requiring urgent referral within days to weeks, despite only 3.7% of admitted patients undergoing MRI during the study period. Psychiatrically relevant abnormalities were found in 32.0% of scans. Abnormalities were more likely to be found in the presence of cognitive impairment, older age, and longer duration of psychiatric disorder. Psychiatrically relevant abnormalities had further associations with older age at onset of the psychiatric disorder and a weak association with abnormal neurological examination. Multiple indications for imaging were present in 57.0% of patients; the most common indications were physical, neurological, and cognitive abnormalities. Brain MRI is a useful part of psychiatric management in the presence of certain neuropsychiatric risk factors. The present findings suggest that treating teams can judiciously tailor radiological investigations while limiting excessive imaging. Future research in larger cohorts across multiple centers may contribute to shaping more consistent neuroimaging guidelines in psychiatry.

The bias in the nomenclature of large-vessel vasculitis.

Dear Editor, A 68-year-old man of Northern European ancestry presented with a 3-month history of constitutional symptoms to his general practitioner. The detection of a normochromic normocytic anaemia, an acute phase response and an elevated prostate-specific antigen prompted a referral to a rapid diagnostic service for cancer. A CT scan of the thorax, abdomen and pelvis did not detect any solid tumours but commented on thickened aorta. An urgent referral was made to the vasculitis clinic. In the interim he received a short course of prednisolone which had finished more than a week ago. On attendance in vasculitis clinic, he had no organ-specific symptoms. Constitutional symptoms included weight loss of >5 kg, drenching night sweats and fatigue. He reported feeling slightly better over the last few weeks. He did not have any risk factors for atherosclerosis. On direct questioning, he admitted to a mild frontal headache (which had been reported as being absent in the primary care referral letter), anterior neck pain and symmetrical shoulder pain. On examination, there were no nail changes or detectable lymphadenopathy. The radial pulses and blood pressure were difficult to elicit in both arms, but the extremities appeared well perfused. There were harsh bruits over both subclavian and axillary arteries. Carotid arteries did not exhibit bruits and were non-tender. There were no abnormalities in relation to the superficial temporal arteries.

A Rare Foreign Body in a Patient with Poor Dentition: A Satay Skewer

Foreign body (FB) ingestion and impaction in the upper gastrointestinal tract is a common urgent referral to otorhinolaryngology. The types of FB are significantly different between children and adults, and it largely depends on the region, sociocultural influences and dietary habits of the patient. Rare FBs in adults should be suspected in certain groups of people with psychiatric illnesses and in patients with dental pathology who are unable to chew food properly before swallowing. In this report, we present a rare case of oesophageal impaction by a long satay skewer with sharp ends along with chicken meat in a 37-year-old man with poor dentition. It was successfully removed using rigid oesophagoscopy.

Outcomes of a Hybrid Ophthalmology Telemedicine Model for Outpatient Eye Care During COVID-19

The hybrid ophthalmology telemedicine model asynchronously pairs an imaging appointment by a technician with a subsequent virtual appointment by a clinician. Although it has been mentioned in several studies as an alternative to standard in-person care during the COVID-19 pandemic, outcomes of this alternative clinical care model remain to be evaluated. To investigate the outcomes associated with the hybrid ophthalmology telemedicine model during the COVID-19 pandemic for nonurgent and nonprocedural ophthalmological care. Retrospective, cross-sectional study of all hybrid visits scheduled during the year 2020 in a single academic, hospital-based eye clinic in Boston, Massachusetts. All hybrid ophthalmology telemedicine visits completed in the year 2020 by opthalmologists and optometrists were included. Data were analyzed from January to December 2020. Hybrid telemedicine clinical encounters. Four outcome metrics were calculated: (1) need for subsequent procedure visit, (2) medication change, (3) nonurgent, and (4) urgent consultation with another eye clinician. Adverse outcomes were defined as irreversible vision loss and the need for additional in-person evaluation to reach a management decision. From April 9 to December 30, 2020, 889 patients (506 female patients [56.9%]; mean [SD] age, 62.1 [14.5] years; age range, 13-98 years) completed 940 hybrid visits. The most common visit indications were glaucoma (424 visits [45.1%]) and retinal diseases (499 visits [53.1%]). A total of 25 visits (2.7%) led to a procedure, 22 visits (2.3%) led to a change in medication, and 44 visits (4.7%) were referred for nonurgent consultation with another subspecialty with no instances of urgent referrals. Sixteen patients (1.7%) were referred to the on-call clinician for a same-day emergency in-person visit or recommended for a subsequent standard in-person visit to reach a management decision. There were no cases of irreversible vision loss following a hybrid visit. These findings suggest that with the appropriate patient selection and clinical setting, the hybrid ophthalmology telemedicine model may be a good alternative to standard in-person visits, particularly for patients with glaucoma and retinal diseases.

Primary care triaging of head and neck cancer referrals using the head and neck cancer risk calculator version 2: impact on a tertiary head and neck service.

This study aimed to investigate the use of the head and neck cancer risk calculator version 2 in a primary care setting and to evaluate the impact of the risk calculator on the number of referrals stratified by urgency and cancer yield. Referrals between April 2019 and August 2019, April 2020 and July 2020 (pre-risk calculator) and August 2020 and July 2021 (post-risk calculator) were analysed. Referral urgency, head and neck cancer risk calculator version 2 score, cancer diagnosis, cancer type and further investigations were recorded. The 2023 patient encounters were analysed; there were 1110 (55 per cent) referrals before head and neck cancer risk calculator version 2 use and 913 (45 per cent) after head and neck cancer risk calculator version 2 use. A higher proportion of older (p < 0.001) and male (p < 0.013) patients were seen post-head and neck cancer risk calculator version 2 use. All cancer cases were seen on the urgent suspicion of cancer pathway post-head and neck cancer risk calculator version 2 use; however, a higher proportion of patients were seen as urgent suspicion of cancer (51.1 vs 83.5 per cent; p < 0.001). Overall, the cancer diagnosis rate increased from 2.7 to 4.1 per cent. The head and neck cancer risk calculator version 2 had high sensitivity in cancer diagnosis. More studies are required to optimise the predicted versus actual cancer probability gap.

983 Temporal Artery Biopsy - Bringing About a Much-Needed Change

Abstract Aim Looking into the process for sending a referral for a Temporal Artery Biopsy (TAB) and the causes of delays for the procedure at a local DGH. Method A retrospective review of all the TAB referrals sent and the time from referral to date of procedure over the past year done from11/2020 to 11/2021 was done. Specifically noticed points included urgency, side, time till date of procedure. Results Out of the 47 procedures done, 36% of the referrals were sent and about 64% were sent as urgent all of which were sent as emails to secretaries. The average time from referral to date of procedure was about 16 days, however urgent inpatient referrals with severe active symptoms were done by the 6th or 7th day from referral. About 7% of the referrals did not even include site required and 10% did not specify date since use of steroids. About 10% of the patients found to have not understood the procedure completely and its necessity which also contributed to delays. Conclusions This study found that a significant proportion of the TAB referrals were incomplete, that there was a need to re-review the entire patient information thus ending up in delays. A consensus to create a new referral system specifically for TAB which includes all the relevant data for the surgeon and a new patient leaflet including a consent form which has been discussed and is in the stage of implementation for streamlining the process, improving patient experience, and causing positive impact on overall department functioning.

Red Eye/Pinkeye

Key Points Not all red eyes are conjunctivitis, and the differential for a red eye is broad, including infectious, allergic, traumatic/irritant, rheumatologic, and oncologic etiologies.Conjunctivitis is inflammation and injection of the usually transparent conjunctival tissue that covers the outer portion of the eye and inner eyelids. It is often a diagnosis of exclusion after ensuring more severe or vision-threatening etiologies of red eye are not present.The most common etiology for conjunctivitis in children is viral and treated with supportive care. Viral conjunctivitis often begins unilaterally with serous or mucoid discharge, and then may become bilateral. Bacterial conjunctivitis is most often unilateral with purulent discharge and most often treated with topical antibiotics.Indications for urgent referral and treatment include a red eye with one or more of the following: severely painful eye movements or severe foreign body sensation, photophobia, decreased visual acuity, fixed pupil, proptosis, redness in a "ciliary flush" pattern (redness localized to or more pronounced in a ring around the limbus), corneal ulceration or opacity, suspected Neisseria gonorrhoeae infection or herpes simplex virus conjunctivitis, or history of chemical burn or penetrating trauma.

Optometry independent prescribing during COVID lockdown in Wales

IntroductionDuring the COVID‐19 lockdown, primary care optometry services in Wales moved to a hub model of provision. Three independent prescribing models were available in different areas: a commissioned Independent Prescribing Optometry Service (IPOS), independent prescribers that were not commissioned and no independent prescribers available. This allowed a unique opportunity for comparison.MethodOptometry practices completed an online survey for each patient episode. Analysis of the data gave insight into patient presentation to urgent eye services and the drugs prescribed by optometrists. Medicines prescribed, sold or given and onward referral were compared between areas with an IPOS service (n = 2), those with prescribers but no commissioned service (n = 2) and those with no prescribers (n = 2).ResultsData from 22,434 reported patient episodes from 81 optometry practices in six health boards between 14 April 2020 and 30 June 2020 were analysed. Urgent care accounted for 10,997 (49.02%) first appointments and 1777 (7.92%) follow‐ups. Most (18,006, 80.26%) patients self‐referred. The most common presenting symptom was ‘Eye pain/discomfort’ (4818, 43.81% of urgent attendances). Anterior segment pathology was the most reported finding at first (6078, 55.27%) and follow‐up (1316, 74.06%) urgent care appointments. Topical steroids (373, 25.99% of prescriptions) were the most prescribed medications. More medications were prescribed in areas with an IPOS service (1136, 79.16% of prescriptions) than areas with prescribers but no commissioned service. There were more follow‐up appointments in optometric practice and fewer urgent referrals to ophthalmology in IPOS areas.ConclusionUrgent care services were most utilised by patients with discomfort caused by anterior eye conditions. IPOS services enabled optometrists to manage conditions to resolution without referral and without reduction in medications sold or given. Commissioners should recognise the value in reducing burden in urgent ophthalmology and the need for follow‐up as part of a commissioned independent prescribing service.

WE5.1 Review of acute referrals to Surgical SDEC at a DGH

Abstract Aim We intend to interpret the pathway that patients attending Surgical SDEC followed in this journey, at first contact point, their experience at each stage of contact with emergency services and reasons for taking the final pathway. Method We formed an anonymised questionnaire for patient pathway to SDEC, filled on arrival at SDEC. First 53 patients were included from 1 week data. This included the reason for their visit, duration of their presenting problem and whom they called before attending or being directed to SDEC and patient experience with each provider such as 111, 999 and GP in brief. Finally, we observed who they contacted and how urgent they thought their problem was. Result There were 53 patients, 50 responding for themselves. 51 of 53, agreed that they would contact GP or 111 for non-urgent queries. 41/53 77.35% approached their GP initially and we found that 58.5% were referred to SDEC. Of the 32 (37.7%) patients seen by GP, 24 (58.5%) were referred to SDEC. 20% thought they were too urgent for GP. We found that GPs were managing most urgent referrals (38%) and the majority of these were referred to SDEC as in the case of 111 responders. Conclusion Changes introduced by the Long Term Plan were well received by patients with majority of patients being seen in SDEC. The first patient contacts also resulted in SDEC referrals from the community and it would be appropriate for such referrals to be sent directly to SDEC by GPs and 111.

TH1.2 Referral of patients with breast pain to breast clinic: a retrospective analysis

Abstract Aims Previous literature provides evidence that in patients with breast pain and a normal breast examination, the incidence of ipsilateral breast cancer is approximately equivalent to the screening incidence. Isolated breast pain is not an indication for a suspected cancer pathway referral as per NICE guidance. We assessed all breast clinic referrals in one month for use of the appropriate referral pathway for patients with isolated breast pain, and correct primary care management of breast pain. Methods GP referral letters and breast clinic letters were analysed retrospectively using an electronic clinical data system for all 173 patients referred to breast clinic in September 2021, of which, 47 patients satisfied eligibility criteria. Letters were assessed for urgency of referral and documentation of GP interventions for breast pain (bra fitting advice, simple oral analgesics and topical NSAIDs). Results 62% of patients presenting with isolated breast pain were referred under a USC or urgent referral pathway to breast clinic. Only one patient with breast pain as a symptom, had documented evidence of GP interventions for breast pain. Conclusions The majority of patients presenting with isolated breast pain were inappropriately referred under urgent pathways, potentially impeding capacity in breast clinic for patients that satisfied USC criteria. There was little evidence of GP interventions for breast pain which could negate need for a clinic appointment or alleviate symptoms in the interim. Further GP education could reduce inappropriate urgent referrals of patients with isolated breast pain and improve breast pain management.

Risk factors associated with distress among postoperative patients in an academic gynecologic oncology practice (482)

<b>Objectives:</b> Distress is higher among gynecologic oncology patients than other cancer types and is correlated with poor clinical outcomes and decreased quality of life. The purpose of this study was to determine risk factors associated with elevated National Comprehensive Cancer Network Distress Thermometer (NCCN DT) results among patients in gynecologic oncology practice. <b>Methods:</b> A retrospective chart review of all visits at a single gynecologic oncology practice between September 2016 and December 2020 was performed. Distress was measured using the NCCN DT, administered at the postoperative visit for every patient undergoing surgery in practice. DT were analyzed as discretized values (DT < 3=low distress, DT 4-8 = moderate distress, or DT, ≥9 = high distress), chosen based on clinic thresholds for distress score intervention. Patients with a score > 4 received a referral to social work, with an urgent referral for a score >9. Univariate and multivariate logistic regression analyses were performed to analyze differences in NCCN DT results by multiple personal, demographic and disease-related variables. Risk factors were determined using the Wald test with Bonferroni correction for univariate analyses. The threshold for statistical significance was set at <i>p</i><0.05. <b>Results:</b> A total of 1798 NCCN Distress Thermometers were collected at postoperative visits and included in the analysis (mean age: 58.31± 13.98 years, mean BMI: 31.66± 9.42). Ovarian (36.51%) and endometrial cancer (31.74%) were the most common cancers. More than half (59.07%) of patients reported a partnered relationship status and had private insurance (56.73%). Benign pathology was known prior to completion of the NCCN DT in 13.07% of patients. Most patients (71.64%) endorsed a low level of distress. A moderate level of distress was reported by 26.53% of patients, whereas a minority of patients (1.84%) documented a high distress level. Increasing levels of distress were significantly associated with a history of depression (p=.001), tobacco use (p=.007), and vaginal cancer (p=.008). Knowledge of benign pathology prior to completion of NCCN DT (p=.023) was associated with low levels of distress. <b>Conclusions:</b> More than a quarter of women undergoing surgery in a gynecologic oncology practice reported moderate or high distress at their postoperative visit. Understanding of risk factors provides opportunities to identify patients most at risk for experiencing high distress. Patients with known benign pathology demonstrated decreased distress, indicating that surgical intervention alone does not significantly impact levels of distress. Association between unmodifiable risk factors and distress, such as vaginal cancer, provides an opportunity for targeted intervention early in the treatment course, while the association with modifiable risk factors (tobacco use, depression) provides insight into counseling and prevention strategies.

Multiple liver lesions leading to urgent referral.

A young patient was referred urgently to our centre following an ultrasound scan which revealed multiple liver lesions. The patient was asymptomatic with no significant past medical history. Physical examination was normal. Liver function tests and liver screen were normal. Magnetic resonance imaging (MRI) revealed multiple small T2 hyper intense lesions throughout the liver (Figs. 1 and 2).

An integrated discrete event simulation and particle swarm optimisation model for optimising efficiency of cancer diagnosis pathways

The National Health Service (NHS) constitution sets out minimum standards for rights of access of patients to NHS services. The ‘Faster Diagnosis Standard’ (FDS) states that 75% of patients should be told whether they have a diagnosis of cancer or not within 28 days of an urgent GP referral. Timely diagnosis and treatment lead to improved outcomes for cancer patients, however, compliance with these standards has recently been challenged, particularly in the context of operational pressures and resource constraints relating to the COVID-19 pandemic. In order to minimise diagnostic delays, the National Physical Laboratory in collaboration with the Royal Free London (RFL) NHS Foundation Trust address this problem by treating it as a formal resource optimisation, aiming to minimise the number of patients who breach the FDS. We use discrete event simulation and particle swarm optimisation to identify areas for improving the efficiency of cancer diagnosis at the RFL. We highlight capacity-demand mismatches in the current cancer diagnosis pathways at the RFL, including imaging and endoscopy investigations. This is due to the volume of patients requiring these investigations to meet the 28-day FDS target. We find that increasing resources in one area alone does not fully solve the problem. By looking at the system as a whole we identify areas for improvement which will have system-wide impact even though individually they do not necessarily seem significant. The outcomes and impact of this project have the potential to make a valuable impact on shaping future hospital activity.

Characterising Australian memory clinics: current practice and service needs informing national service guidelines

BackgroundMemory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs.MethodsThe ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care.ResultsResponses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities.ConclusionsIn comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases.