Quality of referral of short children to the paediatric endocrinologist and impact of a fax communication system.
OBJECTIVE
In 2001, a chart review of children referred to the authors' endocrine clinic because of short stature revealed that many were referred with insufficient baseline data, had normal height velocity and were within genetic target height. Therefore, a two-way fax communication system was implemented between referring physicians and the authors' service before the first visit. Aspects that were assessed included whether this system increased the information accompanying the patient at referral, resulted in children with nonpathological shortness not being seen in the clinic, and was used differently by paediatricians and general practitioners.


METHODS
Between January and December 2006, 138 referrals for short stature, diagnosed with familial short stature, constitutional delay or idiopathic short stature, were audited (69 with and 69 without previous fax communication). Data collected included source of referral, clinical information provided, available growth measurements, and results from laboratory and imaging studies.


RESULTS
Fax communication resulted in growth curves being provided more often (95.6% of cases versus 40.5% of cases without fax communication [P<0.001]) and more investigations being performed by the referring physician (median [range]: six [zero to 13] investigations versus one [zero to 11]; P<0.001), as well as a diagnosis of nonpathological short stature being given to 31 children based on the growth curve, laboratory and imaging results, without the children being seen in the endocrine clinic. Fax communication was also used more frequently by paediatricians (84%) than by general practitioners (15%).


CONCLUSIONS
The fax communication system resulted in a more complete evaluation of referred patients by their physicians and reduced the number of unnecessary visits to the authors' specialty clinic while promoting medical education.
Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec.
Lyne
L
Chiniara
Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec.
Rebecca J
RJ
Perry
Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec.
Guy
G
Van Vliet
Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec.
Céline
C
Huot
Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec.
Cheri
C
Deal
Constitutional delay; Familial short stature; Growth disorders; Idiopathic short stature; Patient triage; Short stature