Hewitt Stephen, Yates Ben, Williamson David
Department of Orthopaedic surgery, The Great Western Hospital, Marlborough Road, Swindon, Wiltshire SN3 6BB, United Kingdom.
Foot (Edinb). 2011 Dec;21(4):166-71. doi: 10.1016/j.foot.2011.03.002. Epub 2011 May 10.
In order to ensure we provided an appropriate patient focused service we undertook a prospective audit of referrals to our surgical foot and ankle department in a large District General Hospital/Treatment centre.
An audit was conducted over a 12 month period to establish the initial referral patterns to a dedicated foot and ankle service. This was undertaken by completion of a dedicated audit form, with departmentally agreed terms and domains following the International coding of diseases (ICD) system. The form was completed by the attending clinician for each new patient contact and the information gathered included referral source; attending clinician; diagnosis; investigations; treatment; and ongoing referral patterns.
1133 referrals were received over a 12-month period. Of these 974 [86%] were referred from their general practitioner. 118 patients had a secondary concern and 12 had a third complaint. For ease, the presenting complaints were clustered under six sub-headings; first ray {426}; lesser rays {324}; rear-foot {111}; tendonopathy/ligament/soft tissue {288}; mid-foot {72}; systemic/general {158}. 775 investigations were requested. These were subdivided into their specific modalities. Treatment included surgery for {65%}; steroid injection {12%}; Orthoses {17.4%}; Advice {13%}; Physiotherapy {3.4%}.
Only 65% of GP referrals to this surgical service were deemed appropriate as they progressed directly to surgery. However, it is important to establish what constitutes 'appropriate' since within the remaining 35% of referrals only 66 (5.8%) required no intervention at all. Of the residual group who required 'treatment' approximately 17% required steroid injection or orthoses and 143 (13%) received advice and went away to contemplate the consultation. Referral pathways could be improved by greater communication between GP and foot and ankle service with the construction and implementation of referral guidelines which would enhance the referral and treatment pathway to the service.
为确保我们提供以患者为中心的适当服务，我们对一家大型地区综合医院/治疗中心的足踝外科转诊情况进行了前瞻性审计。
在12个月期间进行了一项审计，以确定专门足踝服务的初始转诊模式。这是通过填写一份专门的审计表格来完成的，表格中的术语和领域经部门商定后遵循国际疾病分类（ICD）系统。该表格由主治医生为每位新患者填写，收集的信息包括转诊来源；主治医生；诊断；检查；治疗；以及持续的转诊模式。
在12个月期间共收到1133例转诊。其中974例[86%]来自全科医生。118例患者有次要问题，12例有第三个主诉。为便于分析，现有的主诉归为六个小标题下；第一跖骨[426]；其他跖骨[324]；后足[111]；肌腱病/韧带/软组织[288]；中足[72]；全身性/一般性[158]。共进行了775项检查。这些检查被细分为具体的方式。治疗包括手术[65%]；类固醇注射[12%]；矫形器[17.4%]；建议[13%]；物理治疗[3.4%]。
在转诊至该外科服务的全科医生转诊中，只有65%被认为是合适的，因为这些患者直接进入了手术阶段。然而，确定什么构成“合适”很重要，因为在其余35%的转诊中，只有66例（5.8%）根本不需要干预。在需要“治疗”的剩余患者中，约17%需要类固醇注射或矫形器，143例（13%）接受了建议并回去考虑会诊。通过全科医生与足踝服务部门之间加强沟通，并制定和实施转诊指南，可以改善转诊途径，这将加强该服务的转诊和治疗途径。
