{
  "abstract": "Background University Hospital Lewisham is a busy district general hospital in South London. Cardiology Registrars are under significant pressure from the number of referrals received daily. This creates a difficult balance between service provision and training needs. Anecdotal evidence from registrars suggested that referral quality was poor or inappropriate and therefore more time consuming. Patient experience was also seen to be compromised, having to wait to be seen by specialists to initiate management plans that could have been started by their parent team, if they felt more empowered to do so.Aim To audit the quality and number of referrals received by the Cardiology department over a one-month period.Methods Referrals were documented via a shared spreadsheet by the department’s registrars. The Royal College of Physicians (RCP) ‘Referring Wisely’ document 1 outlines the five most common referrals where knowledge of required management should be within the knowledge domain of all physicians. These conditions are stable chest pain, breathlessness-heart failure, murmur, palpitations – including atrial fibrillation and syncope. Referrals were checked against their guidance, to establish whether they were appropriate for speciality advice, or should be within the remit of a general physician’s practice. Other markers for referral suitability reviewed were whether a clear question was asked; if the referral had been discussed with a senior and whether relevant investigations had been completed. The number of referrals, duplications and means of referral were also documented.Results 151 referrals were made to the Cardiology department between1st of November to the 2nd of December (inclusive). The mean number of referrals per day was 10.1, with 21.8% of referrals being duplicates. 40.67% of referrals were regarding conditions under RCP’s general capability list and only 45.1% of referrals asked a clear question. Over 84.8% of referrals were discussed with a consultant and 81.6% of referrals had relevant investigation results included.Limitations Four key limitations were identified in our audit. Strike days took place over 4 days of data collection which would have impacted referral numbers. Secondly, there are other reasons that referrals may have been inappropriate, e.g. parent team having already been given a plan from a tertiary centre. Finally, the data analysis relies on the quality of the documentation. Referrers may document a senior clinician’s name who is on call, rather than actually discussing the case with them. Furthermore, the quality of the referral relies on the quality of the referrer’s documentation, rather than the senior clinician requesting it.Conclusion Poor referral quality and duplication can increase registrar workload and compromise training opportunities. Simple interventions such as education to referrers on the importance of asking a clear question and confidence around common cardiac conditions could help alleviate this pressure, and arguably more importantly, improve patient experience by reducing waiting time for appropriate management. Our department is conducting teaching on appropriate referrals and RCP guidance as part of the Acute Medical Departmental teaching program and look forward to re-auditing referrals afterwards.References Royal College of Physicians. Referring wisely. London: Royal College of Physicians; 2017. Available from: https://www.rcp.ac.uk/media/1ondl1nr/referring-wisely.pdfAbstract 128 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Sara Khalid"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Susannah Dabbaj"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Robert Bowen"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Moosa Nadheem"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Alvaro Garcia-Ropero"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Amar Singh"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "William Eysenck"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Zeeshan Khawaja"
    },
    {
      "affiliations": [
        "University Hospital Lewisham, London, United Kingdom"
      ],
      "name": "Norildin Al- Refaie"
    }
  ],
  "title": "128 Investigating the quality of cardiology referrals with the aim of improving registrar and patient satisfaction",
  "uid": "d02b3e8d-50da-5dab-8d9c-1032f6a10f1e"
}