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PTH-049 The Split Clinic – A Prescription For Efficiency In The Gastroenterology Outpatient Clinic
  1. MF Jaboli,
  2. M Grimes,
  3. H Palmer,
  4. C Clayman,
  5. T Rayne,
  6. C Durcan,
  7. I Mason,
  8. O Epstein
  1. Gastroenterology, Royal Free Hospital, London, UK

Abstract

Introduction Worldwide, healthcare providers are striving to balance escalating costs with the patient’s expectation of efficient access to specialist opinion, rapid investigation and treatment. Over the past 65 years, the NHS gastroenterology outpatient journey has remained unchanged. Patients are assessed at the first visit, followed by one or more hospital visits for gastrointestinal investigations and a return hospital visits for final assessment. The split clinic has been designed, wherever possible, to condense the journey from weeks or months to hours.

Methods Over a period of three months, each gastroenterology referral letter was previewed four to six weeks prior to the outpatient appointment, and each patient was triaged as “Solution” and “Complex”. For the solution cohort, investigations were predicted and booked for the same day as the outpatient visit. The patients were asked to attend clinic starved and told to expect one or more same day gastrointestinal investigations. On the appointment day, “Solution” patients attended the split clinic for an initial assessment, then proceeded to investigation, returning thereafter to the clinic for feedback.

Results Of 174 referrals, 95 patients were triaged from the referral letter as “Solution” patients, and 81 attended the split clinic (7 did not arrive, 4 postponed, 3 direct to surveillance colonoscopy). In those who attended, 46 same day tests were performed (14 upper endoscopies, 11 sigmoidoscopies, 5 barium swallows, 6 Eso Capsule endoscopies, 5 ultrasound scans, 1 electrogastrogram, 2 CT abdomen and 2 CT colonoscopy). Twenty-seven patients (34%) were discharged, and twenty-two (27%) were discharged after a single follow up telephone consultation. Overall, 49 patients designated as “Solution” patients (60%) required only a single hospital visit. Sixteen patients (17%) were re-designated as “Complex” requiring further tests and 3 (3%) were referred elsewhere. Overall, 95 (46 same day tests and 49 return to follow up clinic in old system) return hospital visits were avoided and the attended to discharged ratio was 81:27 (1:0.3).

Conclusion Analytical triage of GP referral information allows identification of most gastroenterology “Solution” patients. This facilitates pre-emptive investigation planning and scheduling which, in turn, supports a split clinic designed to condense weeks or months of investigation and follow up into a few hours. The well planned split clinic meets the patient’s expectation for an efficient journey, quick diagnosis and reduced number of hospital visits.

Disclosure of Interest None Declared.

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