‘On-call’ referral patterns of patients with diagnosis of brain tumour: An audit of activity in in

two neurosurgical centres

Nitin Mukerji1, John Crossman1, Joanne Lewis2, Philip J Kane3

1Department of Neurosurgery, Newcastle General Hospital

2Department of Oncology, Freeman Hospital3Department of Neurosurgery, James Cook University Hospital

Background

Patients with a diagnosis of brain tumour commonly referred as ‘on call’ emergencies

Referral taken by the ‘on call’ registrar and discussed with the ‘on call’ consultant

Advice given on management

Implications

EWTD

Advice variable

May not be discussed with a consultant with interest in tumour management

AimsTo audit pattern of referrals into the two

neurosurgical units in NECN

Identify patterns in referral which have potential for modification:improve patient careImprove EWTD compliance

MethodologyDevelopment of ‘on-call’ referrals database at

both units (NM)Completed by on call registrar at end of on-call

periodPatient demographics, reason for referral, advice

given Piloted at JCUH and then introduced to NGH

All referrals in one year period audited (2009)

Results

4751 referrals

451 tumour related9.5% of all on call referrals

Pattern of referrals

Time of day During week

Pattern of tumour referrals

Peak times of tumour referrals

Sources of referrals

Specialties that refer tumours

Source of referrals: time of day

Grade of referring doctors

Referring hospitals-JCUH

Referring hospitals-NGH

Results15% of ‘On-call’ neuro-oncology referrals were

received out of hours

50% of ‘On call’ neuro-oncology referrals were received between 11am and 5 pm.

70% of ‘On call’ neuro-oncology referrals had a GCS 14 or 15

<1% of ‘On call’ neuro-oncology referrals needed emergency surgery

DiscussionImportant baseline data

Monitor impact of transfer of NGH unit to RVI

Scope to develop guidelines to ensure direct referrals to a neuro-oncology

Scope to reduce OOH workload and compliance with EWTD

Further Work

Extend audit to include 2010

Subgroup analysis

Model effects of propsed guidelines