Introduction:
Nephrology services are important in maintaining emergency and routine care for inward patients. The annual health statistics report 2019 mentioned urinary system illness including CKD as the 4th leading cause of hospital admission in Sri Lanka. The reason for admission may be directly related to a kidney issue or a different reason. The patients are admitted to medical, surgical, or other specialty for treatments. Timely involvement of the nephrology team is important in providing standard essential care in certain instances during inward patient care given at different units. This could be optimizing patients to prevent kidney injuries, treating existing kidney problems, and arranging regular follow-ups. The quality of renal service depends on the adequacy of manpower and infrastructure. This study was designed to explore the details of patient referrals over a year to the nephrology services in a tertiary care hospital.
Methods:
This audit was conducted retrospectively at the nephrology unit at Teaching Hospital, Kurunegala (NU-THK) for one year from 1st of January to 31st December 2023. The information on the date, referring department, gender, and reason for referral was traced from the up-to-date database maintained by the NU-THK. All inward referrals to the NU-THK, except ICU, patients were included in this audit. In addition, the number of referred patients was compared with inward nephrology unit patients. All the data was analyzed using Microsoft Excel.
Results:
1432 patients (58% were males and 42% were females) were referred for nephrology services over the one-year period, during which a total of 3095 patients were managed in male (n=1734) and female (n=1113) nephrology wards, hemodialysis units (n=156), and CAPD units (n=92). Nearly 1/3 of the total nephrology workload was covered by referrals (31.6%). The maximum number of referrals was recorded in April (n=174, 12.15%), while the minimum was 81(5.65%) in October. On average there were 119 referrals monthly. Most patients were referred from the medical department (602, 42 %) followed by the surgical department (244, 17 %). The indications for the referrals were, AKI (581, 40.6%), CKD (277,19.4%), optimization before contrast studies and routine surgeries (230, 16.2 %), obstructive uropathy (80, 5.6 %), post renal transplant infections (18, 1.3%), suspected glomerulonephritis (17, 1.2 %), proteinuria in pregnancy 10(0.70%), and other causes (67, 4.7 %). Further, recorded diagnoses were unavailable for 152(10.6%) patients.
Conclusions:
Inpatient referrals constitute nearly one-third of the nephrology unit's workload. The number of referrals fluctuates throughout the year, with various indications from different patient care units. This audit emphasizes the emerging need of nephrology services for the other departments. Introducing a structured inward referral form for patient referrals will be a useful tool.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.