Endocrine Abstracts (2017) 50 P287 | DOI: 10.1530/endoabs.50.P287

Inpatient endocrinology referrals: does the RCP report 'Referring Wisely' describe who should be referred?

Benjamin Whitelaw1,2, Zoe Davies1, Laura May Davis1 & Paraskevi Xekouki1,2


1King’s College Hospital, London, UK; 2King’s College London, London, UK.


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 Cushing’s, 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 Cushing’s 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.

Table 1
Referral criteriaNumber (total =37)
RCP recommended referralHyponatraemia (severe or symptomatic)14
Thyrotoxicosis5
Adrenal insufficiency5
Thyroid/adrenal/pituitary mass5
Hypocalcaemia4
Amenorrhoea/hypogonadism0
Other referralsCushing’s, DI, suspected pheo, odd TFTs4

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