Canadian Pediatric Endocrine Group
Requesting information such as growth charts or results
of thyroid function tests through fax communication from a referring physician
could reduce the number of unnecessary referrals of children with short stature
to the pediatric endocrinologist, according to a study presented at the
Canadian Pediatric Endocrine Group 2012 Scientific Meeting.
“[Children of short stature] should be investigated
by their referring physician,” Lyne Chiniara, MD, a pediatric
fellow at the Centre Hospitalier Universitaire Sainte-Justine, department of
pediatrics, Université de Montreal, said in an interview with
Endocrine Today. “[Referring physicians] need to do a minimum
number of investigations.”
Chiniara and colleagues conducted an independent audit
of referrals of children with short stature to the hospital’s
endocrinology service in 2001 and found growth charts were provided in slightly
more than half (53%) of 109 referrals, 67 of which were male patients and 42 of
which were female patients. They also found that baseline tests, such as
thyroid function tests or complete blood count, were conducted in the minority
of referral cases: 39% and 30%, respectively.
Pediatricians fared better over general practitioners in
the quality of referrals, referring fewer children with normal height velocity
(P=.01). They also plotted more values on growth charts (P=.02)
and performed more baseline tests (P=.002), Chiniara said.
In 2006, the hospital asked that referrals be received
by fax, and they requested that missing information be sent via fax if it was
not received before the patient consult. Previously, phone calls from
physicians and parents were accepted as legitimate referrals.
“By implementing this system, we received more
baseline data and we could assure the referring physician, based on the data,
that we didn’t need to see the child in the pediatric endocrinology
clinic,” Chiniara said, noting that referrals continued to be accepted
without fax communication to allow referring physicians to make the transition.
The 2006 audit of 138 referrals found that 69 were
received by fax. Of 138 referrals, 65% came from pediatricians, 31% from
general practitioners and 4% from other health care professionals.
Growth curves were obtained in 95.6% of cases in which
fax communication was involved vs. 40.5% of cases in which it was not
(P<.001). Moreover, more baseline investigations were conducted when
fax communication was used (P<.001). The implementation of fax
communication avoided 31 consults with patients; information from growth
curves, laboratory results and imaging did not warrant these consults.
“We have improved the quality of referrals,”
Chiniara said.
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Disclosure: Dr. Chiniara reports no relevant
financial disclosures.