Endocrine Abstracts (2015) 38 P335 | DOI: 10.1530/endoabs.38.P335

Pituitary service review in a District General Hospital: a case for nationally agreed guidelines?

Eveleigh Nicholson, Jana Bujanova, Nadia Zarif & Partha Kar

Queen Alexandra Hospital, Portsmouth, UK.

Background and aims: In 2010 pituitary service improvements were instigated, e.g., creation of local pituitary MDTs/joint pituitary clinics with surgeons. In the absence of national guidelines on post-surgical follow up of pituitary patients there was an evolution of local best practice standards. An audit was conducted in March 2015.

Methods: Twenty-six patients underwent pituitary surgery at local tertiary centre in 2013/14 with endocrine care based at the local District General Hospital (DGH). Standards post-operatively were: Pituitary clinic within 8 weeks; dynamic function tests of an appropriate nature/timing; imaging at 6 months; visual fields between 3 and 6 months; and surgical follow-up within 6 months.

Results: 88.5% of patients were reviewed in the pituitary clinic (68% within 8 weeks). 92.3% of patients had an appropriate dynamic test. With regards to the aforementioned timings, 44% of imaging, 19.2% of visual fields (as documented in notes) and 65.4% of surgical clinics met our standards.

Overview: Good practice was seen in patients reviewed in the correct clinic at an appropriate time, both pituitary and surgical. Tests used showed excellent compliance with local standards. Challenges were faced with timing of follow-up actions. Communication from tertiary hospitals was noted to be variable. Record of visual field tests was patchy.

Action points: Dialogue between DGH and tertiary hospitals has been improved by liaising with neurosurgical juniors to ensure all post-op information is transferred electronically in the future. All visual field reports are to be received and filed on an electronic database in the DGH. Repeat audit in 2016.

Points for discussion: Nationally agreed guidelines for the post pituitary surgery follow up would greatly enhance the patient journey. We would suggest a national database for centers to compare their pituitary service on agreed national guidelines post discussion with Society for Endocrinology.

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