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Medical audit--why children attend out-patient clinics
Insights
Many pediatric out-patient referrals are for non-specific reasons, with 24% showing no abnormality. This study suggests optimizing hospital resource allocation for pediatric care without compromising quality.
Area of Science:
- Pediatric medicine
- Healthcare management
Background:
- The out-patient department of the Royal Belfast Hospital for Sick Children receives 10,000 new referrals annually.
- A significant portion of referrals may not require specialized pediatric care.
Purpose of the Study:
- To analyze the reasons for referral and outcomes of new out-patient pediatric cases.
- To identify opportunities for more rational use of hospital resources.
Main Methods:
- Prospective study of a random sample of 295 (4%) new out-patient referrals.
- Data collection on referral reasons, attendance, investigations performed, and clinical outcomes.
Main Results:
- Referral reasons included investigation/diagnosis (45%), therapeutic advice (47%), and parental reassurance (6%).
- 10% of referred children did not attend appointments.
- 24% of attendees were found to have no abnormality, particularly those referred for reassurance and infants.
- Less than half (45%) underwent investigations, primarily non-invasive (e.g., X-rays, urinalysis).
- Consultant medical staff saw 53% of new referrals, requested more investigations, but were less likely to conduct patient reviews.
Conclusions:
- A substantial number of pediatric out-patient referrals may be for conditions not requiring extensive investigation or specialist intervention.
- There is potential to optimize resource allocation in pediatric out-patient services by refining referral criteria and processes.
- Ensuring appropriate investigations and follow-up care is crucial for efficient pediatric healthcare delivery.
Abstract:
Ten thousand new out-patient referrals are made each year to the out-patient department of the Royal Belfast Hospital for Sick Children. A prospective study of a random sample of 295 (4%) of these children was undertaken to determine their reason for referral and the outcome of their attendance. The stated reason for referral was for investigation/diagnosis (45%), therapeutic advice (47%) or parental reassurance (6%). Non-attenders (10%) could not be predicted from the referral letter. Twenty-four per cent were found to have no abnormality. Significantly more children referred for parental reassurance and infants were included in this category. Less than half (45%) had investigations performed. These were mainly non-invasive with plain x-rays and urinalysis accounting for 44%. Consultant medical staff saw 53% of new referrals and requested more investigations but were less likely to review patients. The information obtained is used to suggest ways in which more rational use of hospital resources might be achieved without decreasing the standard of care to these children.