1. Nitin Mukerji 1, John Crossman 1, Joanne Lewis 2, Philip J Kane 3 1 Department of Neurosurgery, Newcastle General Hospital 2 Department of Oncology, Freeman Hospital 3 Department of Neurosurgery, James Cook University Hospital

2. Background Patients with a diagnosis of brain tumour commonly referred as ‘on call’ emergencies Referral taken by the ‘on call’ registrar and discussed with the ‘on call’ consultant Advice given on management

3. Implications EWTD Advice variable May not be discussed with a consultant with interest in tumour management

4. Aims To audit pattern of referrals into the two neurosurgical units in NECN Identify patterns in referral which have potential for modification: improve patient care Improve EWTD compliance

5. Methodology Development of ‘on-call’ referrals database at both units (NM) Completed by on call registrar at end of on-call period Patient demographics, reason for referral, advice given Piloted at JCUH and then introduced to NGH All referrals in one year period audited (2009)

6. Results 4751 referrals 451 tumour related 9.5% of all on call referrals

7. Time of day During week

8. Pattern of tumour referrals

14. Referring hospitals-JCUH

15. Referring hospitals-NGH

16. 15% of ‘On-call’ neuro-oncology referrals were received out of hours 50% of ‘On call’ neuro-oncology referrals were received between 11am and 5 pm. 70% of ‘On call’ neuro-oncology referrals had a GCS 14 or 15 <1% of ‘On call’ neuro-oncology referrals needed emergency surgery

17. Important baseline data Monitor impact of transfer of NGH unit to RVI Scope to develop guidelines to ensure direct referrals to a neuro-oncology Scope to reduce OOH workload and compliance with EWTD

18. Further Work Extend audit to include 2010 Subgroup analysis Model effects of propsed guidelines