A Qualitative Retrospective Review of Rheumatology Referrals to a High-Volume Community Rheumatology Clinic: The Good, the Bad and the Ugly

Objectives This study aims to critically examine the quality of incoming referrals in a community rheumatology clinic. By identifying gaps in the information provided and recognizing recurring issues, we seek to reduce inappropriate referrals and improve workflow efficiency, support better communication, streamline referral practices, and enhance patient care.

Methods This study assessed the quality of 250 consecutive referrals received at Sunnyside Rheumatology Clinic in Kingston Ontario. We defined our audit standards based on the OMA and CPSO referral recommendations, with the standard that referrals meet 100% of the outlined criteria.

Results While the standard expectation is that referrals meet 100% of the outlined criteria, the analysis of 250 referrals revealed substantial deficiencies in key areas. Notably, 40% of referrals did not include a clearly stated reason for referral, and 60% failed to provide an adequate physical examination. Additionally, 38% of referrals lacked even a description of relevant symptoms. Further gaps included missing personal health history in 10% of referrals, absence of family history in 68%, no allergy documentation in 15%, and missing current or previous medications in 16%. Relevant laboratory work was absent in 26% of referrals, while 34% lacked appropriate imaging. 21% of referrals contained redundant or excessive information. 22% of referrals were returned to the referring physicians with requests for additional information to enable proper triage. Many referrals were rejected outright due to being clearly inappropriate for rheumatology assessment.

Conclusion This study highlights significant gaps in the quality and completeness of rheumatology referrals, underscoring the need for enhanced collaboration among referring physicians regarding appropriate and acceptable referral practices. In addition to improving adherence to established guidelines, there is a need to educate providers on when it is clinically appropriate to refer patients to rheumatology. By targeting services to patients most likely to benefit and improving the referral process, we can enhance workflow efficiency and ultimately improve patient outcomes and unnecessary burdens on consulting physicians.