Optimising neurosurgical outpatient care: a paradigm shift?

Abstract

INTRODUCTION: The Wellington Regional Hospital (WRH) neurosurgical service has noted a substantial increase in patient volumes over the last decade, with referrals to the neurosurgical outpatient clinic appearing to have increased even more substantially. AIM: To quantify the increase in referrals to the WRH neurosurgical outpatient service and to determine whether this has translated into an increase in the number of neurosurgical procedures performed. METHODS: All referrals to the WRH neurosurgical department from the lower North and upper South Islands of New Zealand spanning 10 years were collected. Key outcome data were the number of interventions performed. In addition to GP referrals, all specialist referrals to the WRH neurosurgical outpatient service were also analysed as a comparison. RESULTS: In total, 19 201 patients were referred to the WRH neurosurgical service over the 10 years of the study. Within this timeframe, 7105 patients were referred by GPs and 12 096 were referred by specialist teams. Only 348 patients (4.9%) referred by GPs underwent some form of therapeutic intervention, compared to 3489 patients (28.8%) referred by specialist teams. DISCUSSION: Our data shows that specialist referrals result in a proportionally greater number of therapeutic interventions than GP referrals. This is in part due to the wider array of diagnostic tests available to specialists compared to GPs. The development of relevant guidelines for primary care referral to a neurosurgical service appears warranted and could facilitate initiation of appropriate investigations in primary care. KEYWORDS: Neurosurgery; outpatients; primary health care; referrals

The neurosurgical outpatient clinic: comparison between accesses in public and private activities

“…Probably, before GPs referred patients for neurosurgical consults, they should consider other therapies, such as physical medicine evaluation, infiltrative corticosteroid therapy or evaluation by another specialist. The fact that this does not happen may be due to the lack of guidelines to help general practitioners refer patients with spinal diseases to the neurosurgeon, as also confirmed by a study by Kamat et al [ 3 ] These authors also showed neurosurgeons spend most of their time screening patients rather than operating on them and that an increased number of outpatient clinics did not result in an increased number of surgeries [ 3 ]. Therefore, the development of relevant guidelines for the referral of primary care to a neurosurgery service appears justified and could facilitate the initiation of appropriate investigations in primary care.…”

“…In other countries similar studies have been performed. For example Kamat et al [ 3 ] showed that specialist referrals result in a proportionally greater number of therapeutic surgical interventions than GP referrals. They concluded that the development of relevant guidelines for primary care referral to a neurosurgical service, could facilitate initiation of appropriate investigations in primary care.…”

Could dental school teaching clinics provide better care than regular private practices?

“…As the population ages and lives longer with chronic disease, DSC are regularly called upon to deliver complex care to complex patients. In medicine, there are many examples of a shift from inpatient procedures to outpatient care, which suggests that the differences between teaching hospitals and DSC are reducing.…”