SFEBES2016 Poster Presentations Clinical biochemistry (28 abstracts)
Inpatient Endocrinology: a comprehensive specialty service audit and Quality Improvement Project in a large tertiary care centre
Joannis Vamvakopoulos 1, , John Ayuk 2 , Kristien Boelaert 1, , Neil Gittoes 1, , Niki Karavitaki 1, , Brian Mtemererwa 2 , Michael O’Reilly 1, , Andrew Toogood 2 & Helena Gleeson 2
1University of Birmingham, Birmingham, West Midlands, UK; 2University Hospitals Birmingham NHSFT, Birmingham, West Midlands, UK.
Background: Endocrinology is well-established as an outpatient specialty. However, virtually no data exist on the volume, nature, management and disposal of inpatient referrals to inform the design and delivery of a quality-assured service.
Methods: We undertook an audit of all activity of the Inpatient Endocrine Service at University Hospitals Birmingham NHSFT (IES@UHB) between January 2010 and December 2015. Referrals received electronically via the Patient Information and Communication System (PICS) were collated and information was extracted pertaining to the timing, source, reason for and disposal of each referral; as well as to individual case outcomes (length of stay, readmission rate, mortality).
Results: A total of 2,817 actionable inpatient referrals were received over the audit period, 16% relating to readmissions. Referral volume grew at an average rate of 49.2% year-on-year, from 127 in 2010 to 885 in 2015. Multiple referrals for the same patient over the same episode of care made up 18.8% of the total workload. The majority of referrals originated from medical specialty teams (37.1%), followed by neurosurgery (20.8%); ENT (8.2%); trauma and orthopaedics (6.1%) and others (<5%). Electrolyte derangement was by far the commonest referral reason, principally hyponatraemia (22.3%) and hypernatraemia (3.2%). Other common reasons included advice on hormone replacement therapy (14.6%); disorders of calcium metabolism (10%); and post-operative review of hypophysiectomised patients (6.4%). Median length of stay for referred cases was 15 days and the overall mortality rate over the audit period was 24.5%, with roughly one third of deaths occurring in hospital. Sixty-nine percent of cases with recurrent admissions were followed up in outpatients, compared to 36.5% with non-recurrent admissions.
Conclusions: The IES@UHB serves a high-risk patient population with a wide variety of acute and decompensated chronic endocrine problems. Audit findings are central in streamlining the service; as well as in developing appropriate educational resources for staff.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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