The Royal College of Physicians (RCP) published a report called Referring Wisely in June 2017. The report asked specialty physicians for a short list of conditions they felt would benefit from specialist input in the context of acute inpatient management (recommended referrals). It also asked for a list of conditions which need not be referred (avoid referrals).
Methods: We retrospectively audited inpatient referrals from our electronic inpatient referral system. The indication for referral was then checked against the RCP criteria for referral.
Results: 43 inpatient referrals over one month were identified. These referrals related to 37 patients (6 duplicate or re-referrals). 89% (33/37) of referrals were in the recommended category. Zero (0/37) were from the avoid referral group. Four other referrals were unclassified and these were: suspected Cushings, diabetes insipidus, suspected pheochromocytoma and funny TFTs (Table 1).
Conclusion: The audit demonstrates that current referral patterns are almost completely in line with the RCPs recommendations. Proposed adaptations to RCP list would include:
Diabetes insipidus, suspected pheochromocytoma and suspected Cushings could be included as recommended referrals.
Amenorrhea/hypogonadism could be removed from the list of inpatient recommended referrals.
Adrenal insufficiency category could be adapted to include hypopituitarism.
Assessment of the impact and outcomes of inpatient endocrine referrals is the subject of future work.
|Referral criteria||Number (total =37)|
|RCP recommended referral||Hyponatraemia (severe or symptomatic)||14|
|Other referrals||Cushings, DI, suspected pheo, odd TFTs||4|