Endocrine Abstracts

Over the last few years, there has been an increase in the demand on the National Health Service, with patients presenting to hospital with multiple co-morbidities and increasingly complex needs. The type of endocrine referrals received can vary both in complexity and also between clinicians. The Royal College of physician has published a ‘Referring wisely’ report in June 2017 which aims to improve and streamline the quality of referrals received in each speciality. Two streams of referrals were identified for each speciality, specifically looking at five referrals which were felt to have required special attention as identified from the referring speciality and five conditions that should have been within the knowledge of any physician and therefore, referrals should be avoided. We retrospectively analysed the inpatient referrals and matched this to the RCP criteria for referrals to review if this had been appropriate. During a three month period, it was noted that 32 patients were referred for an inpatient review. 41% (n=13) of referrals were in the recommended category of the RCP report. In the recommended referral group, 4 patients had hyponatraemia, 2 for thyrotoxicosis, 3 for adrenal insufficiency, 1 for Incidentaloma mass, 1 for hypocalcaemia and 1 for amenorrhoea/ hypogonadism. 31% of patients (n=10) were in the avoidable referral group, with hypercalcaemia accounting for all of these cases. 9 patients were found to be unclassified in the RCP report accounting for 34%. This included 1 patient for suspected Diabetes Insipidus, 1 for pituitary insufficiency, 1 for suspected Insulinoma, 3 for hypernatraemia, 1 for weight loss, 1 for subclinical hyperthyroidism and 1 for osteoporosis. This reflects the variety of workload that an endocrine department in a district general hospital can encounter in a three month period.