Achieving Consistency in Clinical Genetics Triage
Irish Study highlights challenges in achieving consistency in Clinical triage in a tertiary referral specialty
An Irish-led study into clinical genetics services highlights the challenges in achieving consistency in clinical genetics triage in a tertiary referral service. The study highlights the particular challenges in the Irish context given our larger average family size compared with UK centres.
Published recently in the European Journal of Human Genetics, Dr Terri McVeigh (consultant oncogeneticist at Our Lady’s Children’s Hospital Crumlin) & Assoc. Prof Sally Ann Lynch (consultant geneticist at the Children’s University Hospital, Temple Street) reported research demonstrating inconsistencies in the way referrals are managed both within and between Clinical Genetics units.
The study which was led by the Dublin team involved a total of 53 clinicians across 6 centres including Dublin, Belfast, Glasgow, Edinburgh, Manchester, & Cardiff. Thirteen simulated referrals (comprising de-identified actual referrals and composed cases based on common referrals) were sent to each centre. Participants were asked to triage each referral by type of appointment, urgency, designated clinician using a standardised triage protocol. The results highlighted local issues that can result in differences between managing referrals between units. Only three of the case referrals had greater than 80% consensus about whether the referral should be accepted for consultation.
Using data from UK National statistics offices & data from UCD Emeritus Professor Tony Fahey (UCD School of Social Policy, Social Work and Social Justice), the group estimated that the average 3 generation family size on the island of Ireland is approximately 64 individuals in comparison to the average English/Scottish or Welsh family size which consists of 19 individuals.
This difference impacts on referral numbers to both Irish genetic centres (Dublin & Belfast), as clinical genetics involves cascade testing of at risk relatives and clearly there are many more relatives that need to be seen on this island in comparison to our neighbours.
The study documents group consensus on the management of several common referral scenarios & recommends a wider discussion on the topic in a European context.
Towards establishing consistency in triage in a tertiary specialty. McVeigh TP, Donnelly D, Al Shehhii M, Jones EA, Murray A, Wedderburn S, Porteous M, Lynch SA. Eur J Hum Genet. 2019 Jan 8. doi: 10.1038/s41431-018-0322-0. PMID: 30622329 Link