Introduction Following the establishment of specialist cancer centres (and other centralised services), increasing numbers of patients are referred for tertiary care. This may have implications for travel, particularly as patients now have to pay travel costs. As a tertiary referral centre for pancreaticobiliary (PB) medicine we are referred patients from across the UK for a specialist opinion on complex benign and malignant PB problems. The established system of an initial face-to-face clinic visit often then requires return visits for investigations or endoscopic intervention, with significant inconvenience and travel costs for the patient. In response to this, we developed a novel, consultant-led telephone clinic (TC) service. The aims of this service were to improve efficiency and patient satisfaction.
Methods A TC service was commenced with prospective data entry into a database over a 12-week period. Data was obtained on the following: patient demographics; postcode; clinical indication; round distances patients would have otherwise travelled if visiting UCLH. The time and cost incurred for visiting UCLH was calculated using the cheapest return train fare to London Euston (nearest train station). Patients were contacted some time after their consultation by an uninvolved member of non-clinical staff to obtain feedback based on a 9-point questionnaire.
Results 77 patients were listed for consultation in 10 separate TC’s. 17 (22%) were excluded (9 did not answer their original TC; 8 did not answer for feedback). Of the 60 patients analysed (35 female, median age 52.5 years), 12 (20%) were new referrals and 48 (80%) follow-ups. The average round distance if otherwise travelling to UCLH was 96 (3–606) miles. The average time and cost for a return trip to UCLH was 155 (8–593) minutes and £27.60 (£7.30–105). Clinical indications were suspected Sphincter of Oddi dysfunction 18 (30%); acute or chronic pancreatitis 12 (20%); cholangiopathy 6 (10%); choledocholithiasis 5 (8%); non-PB gastrointestinal disease 9 (15%). 14 (23%) had formal out patient clinic review following their TC consultation. In 22 (37%) a repeat TC appointment was sufficient and 7 (12%) were discharged. The remaining 17 (28%) were referred for further endoscopic or radiological imaging at UCLH with TC follow up afterwards. All 60 patients either ‘strongly agreed’ (52, 86%) or ‘agreed’ (8, 13%) that the TC service was efficient. 29 (48%) expressed concerns regarding travel costs if visiting UCLH. Only 4 (6.7%) would have preferred to have seen a doctor in person for their initial consultation.
Conclusion We have demonstrated that a TC service is a useful adjunct in helping to deliver an efficient and convenient tertiary PB service, with excellent patient satisfaction.
Disclosure of Interest None Declared.
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