General practitioner referral from the pre-admission clinic – a cautionary tale

Author： McIntyre James Whitlock Paul Keene Graham Edwards Dennis

ISSN： 1475-9918

Source： The Journal of Clinical Governance, Vol.9, Iss.2, 2001-07, pp. : 59-62

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Abstract

A proportion of patients on elective waiting lists are unsuitable for surgery and, to maximise available theatre time, many departments have pre-admission clinics. A prospective audit of 899 consecutive orthopaedic patients was conducted between August 1997 and August 1998 to determine the cause for operations cancelled and, when referred to the general practitioner (GP), the treatment prescribed. Seventy-one patients were cancelled, 49 by the doctor and 22 by the patient. Hypertension was the cause in 28 (57%) doctor cancellations. Based on measurements during a single visit, this method is inaccurate and leads to an overdiagnosis of hypertension. Half of patients deferred for this reason were found to be normotensive on serial measurements by the GP and passed a second health assessment without requiring treatment. This deferral process meant that the GP workload was increased and the patient waited longer for an operation and suffered unnecessarily the anxiety of initially failing the 'health assessment'.We believe that, if shared between the primary care and surgical teams, the pre-admission health assessment would be diagnostically more accurate and lead to less inappropriate referrals to the GP.• Patients awaiting operation could present to the pre-admission clinic with a blood pressure 'result' from measurements recorded by the primary care nurse during the preceding three months.• Where a health-screening programme is available, a proportion of patients invited for healthscreening might be recruited from operative waiting lists.