title: Preclinic investigations accelerate decision-making, reduce delays in treatment and are highly popular with endocrinology patients and staff.
abstract: OBJECTIVE
  Endocrine diagnosis relies on a thorough history, examination and confirmatory biochemical tests. Previously, in our unit, tests were performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted.
  
  
  METHODS
  Clinicians and chemical pathologists reviewed available guidance and local practice to determine the key tests to confirm or refute most common endocrine disorders. A system was developed for clinicians to categorize new referrals into diagnostic groups: for example, nodular thyroid disease or possible polycystic ovarian syndrome. Standard letters were developed and sent to patients explaining the requirement for tests to be performed prior to first hospital appointment. The letters and requests for investigation sets were standardized for each diagnostic group and generated via a one-click automated method. After one year, clinical outcomes were audited and patients and staff surveyed.
  
  
  RESULTS
  The time from referral to confirming diagnosis and starting treatment was halved: mean 11·8-5·7 weeks (P < 0·001). Acute patients were also discharged from clinic earlier: mean 17 to 10·3 weeks (P < 0·005). Ninety four percent patients surveyed had their tests performed easily prior to attending their appointment. Hundred per cent of patients, 100% of hospital staff and 93% referring general practitioners who responded felt the system improved patient care and should continue.
  
  
  CONCLUSIONS
  Performing investigations prior to new patient appointments is practical, popular with staff and patients and has dramatically improved our referral to treatment statistics by reducing delays prior to diagnosis. This system could be used as a model for other departments.
authors.affiliation: Directorate of Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: V
authors.initials: V
authors.lastname: Srinivas
authors.forename: J
authors.initials: J
authors.lastname: Gomez
authors.forename: S
authors.initials: S
authors.lastname: Kerry
authors.forename: F M
authors.initials: FM
authors.lastname: Swords
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D003657:Decision Making; D003953:Diagnosis-Related Groups; D003940:Diagnostic Techniques, Endocrine; D004700:Endocrine System Diseases / Q000175:diagnosis*; D006801:Humans; D017060:Patient Satisfaction; D012017:Referral and Consultation; D013997:Time Factors; D061665:Time-to-Treatment