Endocrine Abstracts

Background: Thorough history taking and clinical examination is vital in the assessment of all medical patients. However, diagnosis of endocrine disease also relies on appropriate biochemical tests. Previously in our unit, tests were only performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted.

Method: In 2009 clinicians, nurses and chemical pathology representatives reviewed available guidance and local practise to determine the key tests required to confirm or refute most common endocrine disorders. A pilot system of processing new referrals was then developed. The new system encouraged clinicians to categorise new referral letters into groups: for example immune thyroid disease, pituitary problem, possible PCOS. All patients identified to fall within a given group were then sent a standard letter requesting them to undergo the most important previously agreed tests prior to their hospital appointment. The secretarial team were then empowered to produce the letters and request the corresponding tests via a one click automated method. Long-term clinical outcomes have now been audited and patients and staff surveyed.

Results: The time from referral to confirming diagnosis and starting treatment (RTT) was halved: mean RTT fell from 11.8 to 5.7 weeks (P<0.001). Acute patients were also discharged from clinic earlier: mean 17–10.3 weeks (P<0.005). 94% patients surveyed had had their tests performed easily prior to attending their appointment. 100% of patients, 100% of hospital staff (consultants, secretaries, clinic and endocrine nurses), and 93% referring general practitioners felt the system improved patient care and should continue.

Summary: Performing investigations prior to new patient appointments is practical, popular with staff and patients, and has dramatically improved our referral to treatment statistics by reducing delays prior to diagnosis. This system could be used as a model for other departments.