Audit of acute referrals to the Department of Dermatology at Waikato Hospital: comparison with national access criteria for first specialist appointment

Abstract

Aim: This audit was designed to compare current referral practice with the Ministry of Health elective services National Access Criteria for first Specialist Assessment (ACA) guidelines, to identify specific problems, and (if possible) to improve the use of acute dermatology services.

Method: Information regarding referral source, information provided, urgency and diagnostic accuracy, time interval between referral and consultation date, and follow-up arrangements was collected via data sheet on each referral received. We confined the audit to acute referrals--ie, 'immediate and urgent cases' from general practitioners (GPs) that had been discussed with the dermatologist by phone, and internal referrals when an urgent consultation had been requested.

Results: More acute referrals came from other hospital departments (74%) than from general practitioners (26%). Acute referrers, especially hospital teams, tended to overestimate the urgency with which a dermatological condition needed to be seen. Information about inpatients was often considered inadequate for triage. GP referrals contained more useful information. GP referral diagnostic accuracy is in keeping with other studies (approximately 50%) but the diagnostic accuracy of hospital doctors is well below this level. All acute referrals were seen within the recommended timeframe. Follow-up patterns were similar (whether referrals came from general practitioners or hospital teams) but for both groups there was a relatively high failure to attend rate.

Conclusions: Inappropriate referrals are time-consuming and reduce our capacity for seeing community patients on the waiting list. To improve referral triage, we recommend that a referral letter that clearly specifies the information that should be provided. The majority of acute referrals did not comply with the ACA guidelines. We recommend applying the ACA guidelines to internal acute dermatology referrals (as well as those from GPs) to reduce unnecessary inpatient reviews, and to provide a better urgent service for those persons who truly require it.