Medical audit--why children attend out-patient clinics.

Ten thousand new out-patient referrals are made each year to the out-patient department of the Royal Belfast Hospital for Sick Children. A prospective study of a random sample of 295 (4%) of these children was undertaken to determine their reason for referral and the outcome of their attendance. The stated reason for referral was for investigation/diagnosis (45%), therapeutic advice (47%) or parental reassurance (6%). Non-attenders (10%) could not be predicted from the referral letter. Twenty-four per cent were found to have no abnormality. Significantly more children referred for parental reassurance and infants were included in this category. Less than half (45%) had investigations performed. These were mainly non-invasive with plain x-rays and urinalysis accounting for 44%. Consultant medical staff saw 53% of new referrals and requested more investigations but were less likely to review patients. The information obtained is used to suggest ways in which more rational use of hospital resources might be achieved without decreasing the standard of care to these children.