Primary Care and the Haematology Department: Referral and management

Abstract

In 2015, we started working on the Improvement Plan of the Outpatient Clinic of the Hematology Department of the Donostia University Hospital. We noticed that many of the cases referred from primary care to the Hematology Department were inappropriate referrals as they had no hematological pathology. An analytical alteration was the main reason for referring patients from primary care. 60% of referred patients presented with one or more of the following 6 alterations according to their blood test: monoclonal gammopathy, leukocytosis, lymphocytosis, neutropenia, monocytosis and/or thrombocytosis. We set up a working group composed of primary care and hematological physicians and nurses. Together, we elaborated guidelines for the referral of patients presenting with any of these 6 analytical alterations. In this document, we suggested a series of studies to be carried out in Primary Care prior to referral, and indicate if follow-up should be carried out in a Primary Care center or in the Hematology Department. We presented this initial document in the Primary Care centers of Donostia and incorporated feedback into a final document. We would like this document to be dynamic and we will modify and update it with suggestions that emerge in response to its use.