E022 Reducing the number of rejected inpatient referrals to the rheumatology department at a district general hospital: a quality improvement project

Background/Aims Inappropriate or incomplete inpatient referrals to the rheumatology department can delay timely specialist input and negatively impact patient care. At Diana, Princess of Wales Hospital (DPOW), a significant proportion of inpatient rheumatology referrals were being rejected due to missing information or non-adherence to referral criteria. Improving referral quality and compliance with established guidelines was identified as a significant measure for optimising inpatient referrals and prompt specialist involvement. The aim of this project was to reduce the percentage of rejected inpatient referrals to the rheumatology unit at DPOW from a baseline of 29.4% to 15% over a 6-month period. Methods A retrospective analysis of inpatient rheumatology referrals received over two months was undertaken. Data were collected on the total number of referrals, the number of rejected referrals, and the reasons for rejection. Root-cause analysis, including a cause-and-effect (fishbone) diagram and driver diagram, identified key contributory factors such as limited staff awareness of referral criteria, unclear referral documentation, and the absence of visible guidance on wards. Two main interventions were implemented: presentation at medical staff meetings on referral requirements and importance of adherence to British Society for Rheumatology (BSR) referral criteria, and display of posters summarising referral criteria for common rheumatological conditions across various medical wards. Repeat data collection was performed to assess the impact on the quality of referrals post-intervention. Results Before the intervention, 10 out of 34 inpatient referrals (29.4%) were rejected as baseline data. Post-intervention data showed a reduction in rejected referrals to 5 out of 29 (17.2%). Feedback showed increased awareness of referral criteria, improved documentation in referrals made, and a decrease in inappropriate referrals. The target of reducing rejections to below 15% is anticipated to be achieved after completing further PDSA cycles with ongoing education and awareness of referral criteria. Conclusion Targeted education and improved visibility of referral criteria effectively reduced inappropriate inpatient referrals in the rheumatology department. Sustained improvement will depend on continued engagement of staff on awareness of referral criteria and regular audit cycles. This project highlights the importance of simple, low-cost educational interventions in improving referral quality and patient care within hospital rheumatology services. Disclosure J.G. Appiah: None.