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Acute Referrals: A Five-Month Case Review in General Practice

This report analyzes acute referrals over five months, detailing the number and types of cases across various specialties. It includes significant case reflections involving patients with diverse presentations, such as pleuritic chest pain, abdominal discomfort, and neurological symptoms. Each case is evaluated for appropriate action, with referrals made where necessary. The summary highlights key findings, including common diagnoses and safety netting strategies for challenging cases, underscoring the importance of thorough assessment and timely referrals in primary care.

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Acute Referrals: A Five-Month Case Review in General Practice

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    1. Acute referrals Metale Biswas GPR

    2. Number of cases over 5 months

    3. Graph of number of cases from each speciality

    4. Number of acute referrals

    5. Significant acute referrals

    6. Cases - reflection 80y male PC 1/7 pleuritic chest pain, worse on movement, had been carrying shopping, dull ache the day before. PMH IHD, HTN, Ex-smoker. Probably MSK but?ACS. Ref MAU Angio, NSTEMI. 74y male PC 1/7 dull suprapubic pain, no urinary symptoms, unwell, vomiting, BO Normal. Abdo soft, testicular tenderness. MSU 1+ leuc, 4+ ket. Too unwell to be simple UTI. Refer urology. AXR, CT scan Gallstones for elective lap chole. 83y female Normally fit and well. Hyperthyroid, palpitations, SOB. Chest clear, I+II+O. ECG changes suggestive of ischaemia ? Old/new. Refer MAU kept in 1 night, nil acute. 31y female PC 5/7 Gradual onset SOB, no cough, no fever, not asthmatic. R sided chest discomfort. Not on OCP, non smoker. Chest - Reduced breath sounds R apex. ? Pneumothorax. Refer A&E CXR normal.

    7. Cases 42y female 1/7 headache, pain R occipital area, R eye blurred vision, N&V, vertigo. Raised cholesterol, ex-smoker. ?CVA. Refer MAU CT/scan and LP - Viral encephalitis. 35y female PC 2/7 Reduced sensation face, inco-ordination. Recent tooth infection, on metronidazole 200mg tds. O/e dysarthria, ataxia. ? S/e of metronidazole, can not rule out CVA. Refer MAU - Kept in one night s/e. 51 y female 1/7 neck pain, back pain, aches all over. Inco-ordination. Smokes 10/day, on HRT. Finger-nose and heel-to-toe difficult. ?Likely back pain, but unable to rule out CVA. A&E nad.

    8. Cases - reflection Age 7 PC 1/52 grumbling abdo pain, fever. Abdo soft, tender RIF, temp 37.8, tachycardia. ?Appendicitis. Refer Surgical team. Not appendicitis. 29y female G1P0+0, 9/40,PC PV bleeding, bright red. Abdo soft, non tender. ?Miscarriage. Refer EPU Scan no FHS Miscarriage. 36y female G3P1+1, 8/40, PC PV bleeding, dark brown. Abdo soft, non tender. ? Miscarriage. Refer EPU Scan no FHS - Miscarriage.

    9. Conclusion History and risk factors Unwell/well Safety netting Grey areas

    10. THANK YOU

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