TBA (17A105)

Analysis of new referrals to the Rheumatology Department Connolly Hospital

Author(s)

Ali Al Shamsi, Maurice Barry

Department(s)/Institutions

Rheumatology Department, Connolly Hospital

Introduction

In order to improve the departmental service, the issue of a reduction in the new referral to the Rheumatology unit is analysed. We assessed 100 new referral to the Rheumatology department at Connolly Hospital during the three months. They were classified into 6 categories: 1. Polyarthropathy , 2. Intra-articular / soft tissue injection, 3. Fibromyalgia, 4. Osteoporosis, 5. Vasculitis & connective tissue disease, 6. Miscellaneous.

Aims/Background

Assess frequency of new referrals in various diagnostic categories to Rheumatology department.

Method

100 consecutive new referrals to the Rheumatology department at Connolly Hospital were collected during the 3 months from September to November 2015. The referrals were classified into one of 6 diagnostic categories. These are: a) Polyarthropathy, b) Intra-articular/ soft tissue steroid injection, c) Fibromyalgia, d) Osteoporosis, e) Vasculitis and connective tissue disease, and f) Miscellaneous

Results

There were 56 patients in the polyarthropathy group. Of these 48 had inflammatory arthritis and 8 were degenerative. Patients were referred for intra-articular and soft tissue steroid injection. Thirteen patients had Fibromyalgia. Of these 4 patients were referred by other specialties and the remainder from General Practice. Five patients were diagnosed with Vasculitis & connective tissue disease. Four patients were referred with Osteoporosis, 2 from General Practice and one each from Orthopaedics and Gastroenterology. Finally 7 patients had miscellaneous conditions. This clinical audit showed that 15% of patients are referred from Primary care for intra-articular /soft tissue steroid injection only. This suggests that teaching General Practitioners to perform commonly performed intra-articular / soft tissue steroid injections could significantly reduce referrals. We have begun teaching GP Registrars how to perform joint and soft tissue injections. Thirteen percent were referred with Fibromyalgia which is a physical manifestation of stress. Improved public awareness about musculo-skeletal pain and stress may reduce referrals. Also improved management pathway e.g. referral straight to physiotherapy or psychologist would also likely reduce referrals. A pilot scheme referring patients with Fibromyalgia directly to a Psychologist based in the Rheumatology Department (and not to the Rheumatologist) has been commenced, in part as a consequence of this audit.

Conclusions

Almost 30% of new referrals to Connolly Rheumatology service could be appropriately managed without requiring the opinion or intervention of a Rheumatologist