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Written advice can provide a safe and acceptable alternative to new patient assessment for selected referrals to haematologists
Author(s) -
Ganly Peter S,
Keeman Helen,
Spearing Ruth L,
Smith Mark P,
Patton Nigel,
Merriman Eileen G,
Gibbons Steve S
Publication year - 2008
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2008.tb01495.x
Subject(s) - medicine , referral , medical diagnosis , emergency medicine , pediatrics , medical emergency , family medicine , pathology
Objective: To measure the safety and acceptability of providing written advice (WA) for selected patients referred to a haematology service, as an alternative to inpatient or outpatient assessment. Design, setting and participants: Review of the initial management and subsequent course of patients newly referred to a tertiary referral hospital in Christchurch, New Zealand, between 16 October 2003 and 8 June 2006. Structured questionnaires were sent to all referring doctors and patients recently managed with WA. Main outcome measures: Numbers and diagnoses of patients managed with WA, early assessment or delayed assessment; re‐referral and treatment details; characteristics of WA letters; and opinions of referring doctors and their patients on the WA process. Results: 26% of new referrals (714/2785) were managed with prompt WA, while 16% (455/2785) received the alternative of delayed assessment. After a median follow‐up of 23 months (range, 8–40 months), 13% of those managed with WA (91/714) were re‐referred back to the same haematologists; 7% (52/714) were assessed in hospital and 2% (15/714) eventually required treatment. There were no deaths due to haematological causes. Over 90% of responding referring doctors said the WA process was rapid and effective, and 77% of recently managed patients were pleased to be treated by their own doctors. Conclusions: Using WA to manage a substantial minority of patients referred to haematologists can be rapid and safe. It is widely accepted by referring doctors.