Endocrine Abstracts

Rapid diagnosis and treatment of Cushing’s syndrome (CS) is essential for good outcomes. Current standards for appropriate timelines for referral are under review by NHSE. Data are required to substantiate standard setting. Knowledge of current referral pathways/processes are required to explore delays in accessing definitive surgical treatment. An audit of referral processes at Queen Elizabeth Hospital Birmingham was undertaken and further expanded to 4 additional tertiary centres in England. Data were collected on adult patients diagnosed with CS and referred for surgery at index hospitals between January 2018 and December 2019. Patients seen privately were excluded until seen in index hospital. Data were collected on demographics, initial referrer and referral pathway and dates of first clinic, subsequent referral to index hospital (if applicable), first index hospital clinic, MDT and definitive surgery. 72 patients were diagnosed with CS; 69 had definitive surgical treatment. 37 patients had pituitary CS, 34 adrenal CS, 1 had ectopic ACTH secretion. Demographics and referral pathways are outlined in table below. Results are given as median averages. Time from initial referral to secondary clinic (39.5 days in all patients, 45 days in pituitary and 35 days in adrenal patients) was shorter than those referred direct to index tertiary clinic (57 days in all-comers, 56 days in pituitary and 62 days in adrenal patients). However, total time from referral to tertiary clinic via secondary pathway was significantly longer (158.5 days in all, 140 days in pituitary and 171 in adrenal patients). The number of diagnostic tests performed in secondary care was 6 in each group. Time from referral to index hospital to MDT was 32, 61 and 22.5 days for all, pituitary and adrenal patients respectively. Time to definitive surgical treatment was 183, 178 and 180 days for all, pituitary and adrenal patients respectively. By mapping average timeline from referral to definitive surgical treatment in CS patients, we’ve highlighted areas of national and hospital-specific delays which can be improved for better patient outcomes. Both secondary and tertiary centres should organise more rapid reviews of patients with a potential diagnosis of CS and minimal investigation criteria should be set before secondary centres involve tertiary centres in management of CS patients.