Endocrine Abstracts

Introduction: The assessment of a new patient in the medical outpatients relies on thorough history taking as well as clinical examination. In particular, biochemical tests are pivotal in the diagnosis of endocrine conditions. Historically, our unit only mostly performed biochemical tests after new patients attended clinic. We proposed that diagnosis and management would be more efficient if this system was reverted, with the aim of minimising the number of clinic appointments. Additional strategies were considered including the use of a telephone clinic to manage patients with thyroid disease.

Methods: In 2016, clinicians and endocrine nurse specialists reviewed local protocols to determine the key tests required to confirm or refute most common endocrine disorders. Subsequently, a pilot system for processing new referrals was created. This system integrated a proforma for clinicians to request pre-clinic biochemical tests dependent on the referral category: examples include PCOS, hyperprolactinemia and hyperthyroidism. Tests were either carried out in the endocrine day unit or by the phlebotomy service. The secretarial team were then empowered to create standard letters for patients including diagnostic test request details. A model was designed to follow-up patients with thyroid disease via a telephone clinic. Long-term clinical outcomes were surveyed.

Results: The time from referral to confirming diagnosis and starting treatment was halved. Referred patients with unremarkable biochemical test results were also discharged earlier. All departmental staff involved in the project, felt the system improved patient care and should continue.

Discussion: The performance of pre-clinic investigations is a practical and cost-effective measure. It proves to be popular with both clinicians and nurse practitioners, and has dramatically improved our referral to treatment statistics by reducing the delays prior to diagnosis. From an economic perspective, the use of telephone clinics appears promising. This strategy could be utilised in the outpatient setting for all medical specialties.