Patel R S, Smith D C, Reid I
Victoria Infirmary, Glasgow, UK.
Eur J Surg Oncol. 2000 Aug;26(5):452-4. doi: 10.1053/ejso.1999.0920.
We aimed to assess the number of unnecessary referrals to a specialist breast clinic, with special reference to urgent referrals, and to compare referrals with published guidelines for referral to these clinics.
We carried out a prospective audit of new patient referrals from primary care to a specialist breast clinic. We assessed the total number of referrals, proportion of urgent and non-urgent referrals, proportion of unnecessary referrals according to published guidelines, waiting times for outpatient appointments and outcomes for these patients.
Of the total of 321 referrals, 35% were urgent. Twenty-eight per cent of urgent referrals and 37% of non-urgent were inappropriate according to published guidelines. Ten per cent of referrals had breast cancer while 90% had benign disease or no pathology.
There is a proliferation of guidelines (NHS, SIGN, BASO, Patients' Charter) for the organization of specialist breast clinics with the aim of providing rapid diagnosis for patients with malignant disease, or reassurance for symptomatic patients that they do not have breast cancer. However increasing numbers of patients are being referred to these clinics with minimal or no pathology, and this is not acknowledged by these guidelines. In this prospective study of referrals from primary care to a specialist breast clinic, one-third of referrals were inappropriate and this inevitably reduced the efficiency of the service provided for patients with significant symptoms.
我们旨在评估转介至专科乳腺诊所的不必要转介数量，特别关注紧急转介情况，并将转介情况与已发布的这些诊所转介指南进行比较。
我们对从初级医疗保健机构转介至专科乳腺诊所的新患者进行了前瞻性审核。我们评估了转介总数、紧急和非紧急转介的比例、根据已发布指南判断的不必要转介比例、门诊预约等待时间以及这些患者的治疗结果。
在总共321次转介中，35%为紧急转介。根据已发布指南，28%的紧急转介和37%的非紧急转介是不恰当的。10%的转介患者患有乳腺癌，而90%患有良性疾病或无病理问题。
目前有大量关于专科乳腺诊所组织安排的指南（英国国家医疗服务体系、苏格兰校际指南网络、英国乳腺外科医师协会、患者宪章），目的是为恶性疾病患者提供快速诊断，或让有症状的患者放心自己没有患乳腺癌。然而，越来越多病理情况极少或无病理问题的患者被转介至这些诊所，而这些指南并未认识到这一点。在这项从初级医疗保健机构转介至专科乳腺诊所的前瞻性研究中，三分之一的转介是不恰当的，这不可避免地降低了为有明显症状患者提供服务的效率。
