Quality Of Referrals For Nerve Conduction Studies And Electromyography To A Tertiary Care Rehabilitation Center

Objectives: To perform an audit of quality of referrals for Electrodiagnosis (EDX)/Nerve conduction studies and Electromyography (NCS/EMG) to a tertiary care rehabilitation center.Methodology: A detailed referral proforma covering all the prerequisites for EDX studies had already been distributed to dependent Defense Forces Hospitals. The data were taken from those proformas and the patients were asked if the referring physician had explained them about the test and if they had gone through the instructions. The reporting time of the patient, if they were late than the appointment time was calculated in minutes. Physician's explanation about the procedure to the patient and provision of information about precautions and contraindications was also included.Results: Of the total 130 registered patients, 85 were males and 45 females. 86 (66.2%) referrals were made by consultants, 42 (32.3%) by residents and 2 (1.5%) by general practitioners. 41 out of total were from consultants and residents in Physical Medicine and Rehabilitation, followed by 22 from orthopedics. Largest number of referrals were from Combined Military Hospital Rawalpindi (43) and Armed Forces Institute of Rehabilitation Medicine (40). The clinicians neither provided clinical notes (62%) nor mentioned the query and provisional diagnosis (53%). Majority (92%) did not provide information about the test to the patient and did not instruct the patient about any precaution to be taken (92%). The patients on the other hand generally read the instructions provided in the request pro forma (54%) and reported well in time for the appointment of procedure (86%).Conclusion: An inappropriate practice in referring patients uncritically for EDX studies was common. Adopting good referral practices seemed crucial for meaningful usefulness of NCS/EMG. Instructions for proper referrals were sent to the concerned hospitals and a repeat audit was planned after one year.