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Sources and types of referral to a haematology department
Insights
General practitioners initiate over half of hematology referrals, often guided by full blood count results. This leads to high-quality referrals, with most patients showing abnormalities.
Area of Science:
- Hematology
- Clinical Audit
- Healthcare Management
Background:
- Outpatient referrals are crucial for specialized care.
- Understanding referral patterns optimizes resource allocation.
- Leeds General Infirmary's hematology department serves a diverse patient population.
Purpose of the Study:
- To audit new outpatient referrals to a hematology department.
- To analyze referral sources, reasons, diagnoses, and outcomes.
- To assess the quality and characteristics of hematology referrals.
Main Methods:
- Retrospective audit of case notes for new hematology outpatients over one year.
- Data collection included referral source, reason, diagnosis, and patient outcome.
- Analysis of referral patterns from general practitioners and hospital departments.
Main Results:
- General practitioners initiated over 50% of referrals, frequently prompted by full blood count (FBC) results.
- Hospital departments accounted for approximately 30% of referrals.
- Most referrals (91%) revealed an abnormality; GP referrals often led to benign diagnoses, while hospital referrals were more associated with malignant hematological diseases.
Conclusions:
- High referral quality to hematology is linked to GP decisions based on FBC results, often after consultation.
- The current referral system appears efficient, with low rates of default and re-referral.
- The study provides insights into referral dynamics and potential impacts of healthcare policy changes.
Abstract:
An audit was undertaken of the case notes of all new outpatients referred to the haematology department at the Leeds General Infirmary over a one-year period. The source, reason for referral, final diagnosis and outcome were determined in each case, along with essential biographical details. The results show that general practitioners initiated over half of all referrals, often prompted by written comments from a hematologist on a full blood count advising them that further tests were required. Almost a third came from other departments at the study hospital and the remainder originated from hospitals outside the district. Most general practitioner referrals were made with a request for a diagnosis. Hospital initiated referrals were more likely to have a final diagnosis of a malignant haematological disease, whereas those from general practice tended to have benign or self-limiting conditions. Ninety-one per cent of patients referred had an abnormality. There were low numbers of both clinic defaulters and those patients required to be re-referred to other specialties. These results suggest that the high quality of referrals is largely due to the general practitioner's decision to refer patients based on the full blood count result. This often occurs after discussion with haematology medical staff. The possible impact of the government's White Paper proposals on this outpatient service is discussed.