Analysis of Haematology Consult Cases to Design a Consult Request Pro Forma in a Tertiary University Teaching Hospital

ABSTRACT

Background and objectives: The Haematology Department in Cork University Hospital (CUH) provides a consult service to other in-house medical and surgical teams, as well as the adjacent affiliated Cork University Maternity Hospital. With the COVID-19 pandemic creating additional pressure for the service, we analysed the consult requests logged from July to December 2021 to identify common consult queries and design a pro forma that could provide guidance on appropriateness before a consult is sought. This will be assessed by the proportion of consult patients who end up attending the Haematology outpatient service before and after the introduction of the pro forma. Methods: Consults received from July 2021 to December 2021 were logged. The main clinical questions were assessed and categorised under one of three divisions which best described the logged query;general/malignant haematology, coagulation and transfusion. Common investigations suggested after the initial consult were also noted. The proportion of consult patients who were given outpatient appointments was calculated. Results: From July 2021 to December 2021, a total of 153 consults were logged. One hundred and eight (70.6%) of these were coagulation consults, 28 (18.3%) were general haematology consults, 14 (9.2%) were malignant haematology consults and 3 (1.9%) were transfusion-related consults. Sixty-four (41.8%) consult patients reviewed were offered an outpatient follow-up. The stated categories will be used as the main themes on the pro forma to assist referring doctors improve clinical care and focus on haematological questions. The back page of this pro forma lists the usual non-haematological causes of possible consults which should be ruled out in advance. Commonly suggested investigations under these different categories are also listed to guide the requesting teams on the most appropriate investigations and reduce the time needed for consultation. Conclusion: This study categorised the most common consults received by the Haematology service in CUH. It provided a basis for designing a pro forma to guide primary teams on the appropriateness of their consults. The use of this pro forma will be evaluated in a future audit to compare the change in the percentage of patients who were given a Haematology outpatient appointment after they were seen as a consult..