TBA (18A182)

Nature and quality of inpatient rheumatology referrals in a tertiary referral hospital

Author(s)

Kieran Murray, Nicholas Rutledge, Qutab Shah, Douglas Veale

Department(s)/Institutions

Rheumatology, Saint Vincent's University Hospital, Dublin 4

Introduction

Consults are an important aspect of the rheumatology service.

Aims/Background

To examine the nature and quality of inpatient rheumatology referrals in a tertiary referral hospital.

Method

All available consults (n=81) were reviewed. Age, gender, urgency and referral source were recorded. The most likely reason for referral was decided by our research fellow. Referral forms were assessed for presence or absence of age/date of birth, gender, location, duration of symptoms, medications, examination findings, reason for consult, urgency and suspected diagnosis. The presence or absence of investigations (any blood result, CRP value and any imaging result) and what referrer details (name, contact details, consultant responsible) were given.

Results

49% of patients were ≥ 70 years old. 68% were female. Referrals were vasculitis (including GCA and PMR) 21%, inflammatory arthritis 20%, crystal arthropathy 19%, connective tissue disease 16%, osteoarthritis 14%, septic arthritis 3%, fibromyalgia 3%, pyrexia of unknown origin 3%, sarcoid 1%, anti-phospholipid syndrome 1% and osteoporosis 1%.
59% of consults came from general medical teams, 14% from acute medicine, 14% from surgery, 3% from psychiatry and 11% from other services.
36% of consults were considered urgent by the referring team (within 24 hours), 64% were routine (within 48 hours).
In 99% of cases, age or date of birth was given. 84 % detailed gender. 78% contained ward. 68% contained bed number. 56% listed urgency.
96% indicated reason for consult. 30% listed duration of symptoms. 21% detailed whether patient known to rheumatology. 57% gave suspected diagnosis. 33% gave medications. 42% detailed any clinical examination findings. 41% reported any blood test. 27% gave a CRP. 44% detailed imaging findings.
49% contained referrer name. 80% had referrer contact details. 70% gave referring consultant.

Conclusions

The majority of consults were elderly, women. There was a wide range of conditions. 3% of referrals were for fibromyalgia, which could perhaps be managed as an outpatient, improving resource utilization. Many referrals lacked important details with less than half including duration of symptoms, medications, examination findings, blood test results or referrer name. An electronic referral system requiring this data is being created.