RT Journal Article SR Electronic T1 Developing integrated symptom-based diagnostic pathways: how do adults with breathlessness currently present to secondary care? JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP PA3752 DO 10.1183/13993003.congress-2016.PA3752 VO 48 IS suppl 60 A1 Irene Valero Sanchez A1 Richard J. Russell A1 Thomas Ward A1 Anoop Babu A1 Rachael Evans YR 2016 UL http://erj.ersjournals.com/content/48/suppl_60/PA3752.abstract AB Introduction: We surveyed adults who presented to respiratory and cardiology outpatients (OPD) or an acute clinical cardio-respiratory decisions unit (CDU) to inform service improvements for the diagnosis of unexplained breathlessness.Methods: We reviewed: 1) all referrals to cardiology and respiratory OPD - March 2015, 2) all admissions to CDU in 96 hours - July 2015.Results: 1) 63/174 referrals from primary care to OPD were for breathlessness: n=56 respiratory, n=2 to both specialities. 38 had unexplained symptoms prior to referral with 35% having ≤1 investigation. Mean time to diagnosis from referral was 16 weeks. There were no inter-speciality referrals.2) 67/156 adult admissions were for breathlessness. 33/67 had unexplained symptoms, of which 17 were discharged within 24 hrs. Of the 33, 61% required simple investigations only and 50% had an EWS of ≤1 on arrival. The median [IQR] duration of breathlessness was 3 [1 - 14] days.Table 1 shows the diagnoses for each setting.Conclusions: Simple investigations are not fully utilized prior to OPD referral for breathlessness. The need for three different approaches to breathlessness services was identified: 1) a diagnostic pathway for primary care, 2) an ambulatory same day service and 3) an earlier diagnostic combined speciality OPD.View this table:TABLE 1. Diagnoses for adults with unexplained breathlessness presenting to secondary care