Requesting information such as growth charts or results of thyroid function tests through fax communication from a referring physician could reduce the number of unnecessary referrals of children with short stature to the pediatric endocrinologist, according to a study presented at the Canadian Pediatric Endocrine Group 2012 Scientific Meeting.

“[Children of short stature] should be investigated by their referring physician,” Lyne Chiniara, MD, a pediatric fellow at the Centre Hospitalier Universitaire Sainte-Justine, department of pediatrics, Université de Montreal, said in an interview with Endocrine Today. “[Referring physicians] need to do a minimum number of investigations.”

Chiniara and colleagues conducted an independent audit of referrals of children with short stature to the hospital’s endocrinology service in 2001 and found growth charts were provided in slightly more than half (53%) of 109 referrals, 67 of which were male patients and 42 of which were female patients. They also found that baseline tests, such as thyroid function tests or complete blood count, were conducted in the minority of referral cases: 39% and 30%, respectively.

Pediatricians fared better over general practitioners in the quality of referrals, referring fewer children with normal height velocity (P=.01). They also plotted more values on growth charts (P=.02) and performed more baseline tests (P=.002), Chiniara said.

In 2006, the hospital asked that referrals be received by fax, and they requested that missing information be sent via fax if it was not received before the patient consult. Previously, phone calls from physicians and parents were accepted as legitimate referrals.

“By implementing this system, we received more baseline data and we could assure the referring physician, based on the data, that we didn’t need to see the child in the pediatric endocrinology clinic,” Chiniara said, noting that referrals continued to be accepted without fax communication to allow referring physicians to make the transition.

The 2006 audit of 138 referrals found that 69 were received by fax. Of 138 referrals, 65% came from pediatricians, 31% from general practitioners and 4% from other health care professionals.

Growth curves were obtained in 95.6% of cases in which fax communication was involved vs. 40.5% of cases in which it was not (P<.001). Moreover, more baseline investigations were conducted when fax communication was used (P<.001). The implementation of fax communication avoided 31 consults with patients; information from growth curves, laboratory results and imaging did not warrant these consults.

“We have improved the quality of referrals,” Chiniara said.

Source: Endocrine Today