Edinburgh Napier University

  Background: Telephone consultations have been shown to be an efficient method of following up over 30% of respiratory outpatients. An initial telephone conversation with new patients has the potential to permit better selection and timing of investigations and reduce the number of hospital attendances by patients. This study was designed to determine how accurately necessary investigations could be determined from the GPs' referral letter and to look at how often follow‐up patients currently attend the hospital before receiving a diagnosis.

Methods: Sixty five sequential follow‐up patients were interviewed and their notes and investigation records examined to determine how many times they had attended for a consultation or for investigations before they received a firm diagnosis. For 28 new referrals the consultants were asked to list the investigations they thought would be necessary: (1) after reading the letter from the referring GP; (2) after they had taken the history from the patient; and (3) after they had examined the patient. A significant change between (1) and (2) and no change after (3) would suggest a potential advantage to taking the patients' history over the telephone.

Results: Patients attended the hospital a mean 2.3 times before receiving a diagnosis and management plan. 44% (94/213) of investigations were not performed on the same day as the patients' clinic visit. With pre‐planning, potentially 76% (71/94) of those investigations could have been performed during the same hospital visit. Reading the GP referral letter alone was not sufficient to predict the investigations needed. The clinical history altered the investigations ordered in 64.3% (18/28) of patients. Subsequent clinical examination only rarely led to further changes.

Conclusions: This study suggests that patients being referred to a respiratory outpatient clinic have had several attendances before receiving a diagnosis and management plan. Taking the history by telephone has the potential to permit accurate selection of the investigations that the patient may need. These investigations could then be arranged before, or synchronously with, the first face‐to‐face consultation and reduce the number of hospital attendances.