341 Improving Plastic Surgery Inpatient Referrals at a Major Trauma Centre: A Closed Loop Audit

Aim Online plastic surgery referrals at the Royal Sussex County Hospital are often incomplete or inappropriate. Establishing reasons for rejection and streamlining referrals will reduce inappropriate referrals and time to assessment and management. Method Referrals between July 2020 and February 2023 were audited, and data used to create a new referral form. Changes included a prerequisite referral checklist, wound assessment section and required clinical photography. Prospective audit was performed over 3 months. Results 1038 referrals were reviewed including 147 rejected referrals (14.2%). The most common reason for rejection was inappropriate referrals (63%), including 31% not requiring surgical intervention and 32% having been referred to the wrong specialty. 41.5% were submitted without clinical photography. Other rejection reasons included patients declining intervention (8.8%), incomplete referrals (7.5%) or duplicates (7.5%). Commonly omitted sections included results (70%), allergies (65%) and medication (16%). Prospective audit after referral form amendments involved 168 new referrals, with 37 rejected (22.0%). The most common reason for rejection remained inappropriate referrals (70.3%, p=0.64). 19% of forms were submitted without clinical photography (p=0.37), despite required confirmation of available photographs. Other rejection reasons included patient declining intervention (10.8%, p=0.09), incomplete referrals (5.4% p=0.07) and duplicates (5.4%, p=0.07). Conclusions Streamlining the referral form reduced incomplete referrals and the number submitted without clinical photography. A prerequisite checklist reduced inappropriate referrals. The new wound assessment section facilitated advice to be given to referrers, diverting patients for local management. The modified referral form will ensure continued improvement in efficiency of the inpatient plastic surgery service.