Auditing indications for GP referrals to lymphoma clinic – time to tighten our criteria?

Abstract

Introduction: Lymphoma is the most common blood cancer in the UK, with over 14,000 people diagnosed per year. Patients suspected of having lymphoma are referred to one of the four lymphoma clinics at Addenbrooke’s hospital either via their GP or another specialist. With rising numbers of referrals, these clinics are increasingly oversubscribed. This results in increased workload for staff and unnecessary stress on both the NHS and the patients who are referred without fitting the haematological criteria outlined on referral forms.

Objectives: To assess the appropriateness of GP referrals to the lymphoproliferative disorder (LPD) clinics at Addenbrooke’s hospital. To evaluate whether a set of suggested stricter referral criteria could safely reduce the pressure on the clinics.

Methods: A retrospective audit was performed on patients referred to Addenbrooke’s hospital from 30/09/2020-14/09/2022. 176 GP referrals were included in the study and patient records were used to gather the following information: reasons for referral, previous history or existing histological diagnosis of LPD, diagnosis made, and whether treatment was required. Data was then analysed using Microsoft Excel.

Key Findings:

1. The most common reason for GP referrals was lymphadenopathy (n=72) but for the majority of these patients, no lymphadenopathy was detected by the consultant on examination in clinic (n=44).

2. Therefore, 66 out of 176 referrals (37.5%) did not meet the suggested stricter referral criteria.

3. Common reasons for inappropriate referrals included “false” lymphadenopathy (not detected in clinic) and isolated “B symptoms”.

4. Of the 66 patients not meeting the suggested stricter criteria, none were diagnosed with LPD.

Conclusions: This audit revealed that over a third of referrals to LPD clinics at Addenbrooke’s hospital did not meet appropriate haematological criteria. Importantly, none of these patients were diagnosed with LPD, demonstrating that adhering to stricter guidelines for GP referrals is feasible without compromising patient safety.