Inpatient consult requests to the rheumatology service of a tertiary hospital: a review
Marianne Riordan, Geraldine M McCarthy
Rheumatology Department, Mater Misericordiae University Hospital, Dublin
With a growing aged population in Ireland, the prevalence of rheumatic and musculoskeletal disorders is expected to increase substantially. The continued auditing of rheumatology services is required to improve service provision and ensure adequate resource availability.
The aim of this audit was to explore the nature and outcomes of inpatient rheumatology consult requests by medical teams.
A retrospective review of inpatient consult requests to the rheumatology service was conducted between the 1st February and 30th April 2019. Referral data were accessed through the hospital’s computer system and analysed using Microsoft Excel. Patient demographics, question from referrer, pre-existing rheumatological diagnosis, referral origin and priority, and repeat consults were extracted. Final diagnosis was determined by reviewing discharge letters.
A total of 136 consults were requested on 124 inpatients. The average age was 65.09 years (range 22-96) and 66 were female (53%). 53 patients (42.7%) had existing rheumatological diagnoses.
48 consults (35.3%) were queries relating to existing diagnoses, including medication advice (n=23). Additional consults related to crystal arthropathies (n=27), vasculitis (n=24) (9 with existing diagnoses), rheumatoid arthritis/inflammatory arthritis (n=14), osteoarthritis (n=11), connective tissue diseases(n=8) (5 existing diagnoses), polymyalgia-rheumatica (n=8), dermato/polymyositis (n=5) (2 existing diagnoses), seronegative arthropathies (n=3), SLE (n=2) and ‘other’ musculoskeletal issues (n=20), 2 were for pyrexia of unknown origin. 3 were for patients who missed rheumatology appointments due to inpatient admission.
Referrals originated from general medical teams (n=89), neurology/stroke (n=18), cardiothoracic surgeons (n=9), general surgeons (n=4), ENT (n=2), psychiatry (n=1) and orthopaedics (n=1). 16 (11.7%) were requested urgently and 12 repeat consults were requested. 36 patients (29%) were offered follow-up outpatient appointments and the rheumatology service took over care of 3 consults. 48 discharge letters (38.7%) did not document the rheumatology consult or final diagnosis.
A majority of referrals were for crystal arthropathy and medication advice for existing rheumatological diagnoses. The provision of further education, particularly with regards medication, might be useful for medical teams. Given the large proportion of discharge letters not mentioning patients’ rheumatology consults, interns, who are largely responsible for discharge letters, might benefit from additional education on the importance of same.