A prospective audit of referral patterns to a dedicated Foot and Ankle surgical service

Abstract 

Introduction

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.

Methodology

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.

Results

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%}.

Conclusion

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.

Keywords: Foot and ankle surgery, Audit, ICD10, Referral patterns, Investigation patterns, Treatment pathways