Improving identification and early referral of pulmonary hypertension patients

Introduction: Pulmonary hypertension (PH) is a complex disorder with limited awareness across medical specialties. On average patients wait two years from the onset of symptoms to diagnosis and this has not changed for over 20 years 1,2 . We intended to improve PH awareness through developing close cross-specialty relationships, multi-disciplinary meetings, educational sessions, and the appointment of a PH nurse specialist. Aim: To evaluate whether the changes in cross-specialty working and PH awareness increased identification and referral of PH patients. Methods: The number and source of PH referrals was prospectively collected over two distinct time periods; before (April 2012 to February 2013, Period A) and after (May 2015 to January 2016, Period B) the changes in cross-specialty working. Results: Referral rates increased by 285% over the two periods from 6.5 referrals per month (n=72) to 24.9 referrals per month (n=224) after the intervention. The number of internal referrals increased by 126% from (4.55 referrals/month in Period A to 14.6 referrals/month in Period B), external hospital referrals (1.2 referrals/month in Period A to 2.1 referrals/month in Period B) and GP referrals (0.8 referrals/month in Period A to 1.8 referrals/month in Period B). Conclusion: The number of referrals has substantially increased over the two time periods. This increase is particularly evident with internal referrals suggesting that increased inter-specialty working is increasing the timely identification and referral of PH patients. 1. Humbert M et al. Am J Respir Crit Care Med 2006;173:1023–1030 2. Rich S et al. Ann Intern Med 1987; 107:216–223.