Introduction With increasing demand on outpatient (OP) services it is imperative to maximise efficiency to optimise patient management, reduce waiting times and DNA rates. Following an audit, the gastroenterology (GI) service felt that ∼30% of referrals did not require to be seen in a secondary care OP setting. In partnership with the CCG we developed a Clinical Assessment Service (CAS) to optimise patient care by ensuring that only the most clinically appropriate patients were seen by a Gastroenterologist, whilst other patients were triaged to a more appropriate managment pathway.
Method From January 2014, Choose and Book Access for GPs for GI referrals was replaced by virtual CAS clinics. All referrals are triaged electronically to determine the most appropriate clinical pathway. The 4 options are: GI OP appointment; diagnostic test – followed by either OP appointment or discharge; refer back to GP with a management plan and advice; or return to GP as inappropriate referral for GI.
Results The CAS service was implemented in Jan 2014 (3820 referrals to date)
14% of referrals have been referred back to the GP as inappropriate.
10% of referrals have been referred back to the GP with Primary Care Management plan.
26% of referrals are sent for a diagnostic test prior to attending an outpatient appointment or being discharged.
DNA rates in outpatient clinics have fallen from 15% to 7.5%.
CAS has saved the health economy ∼£8000 per month
Patients now offered OP appt has reduced from 100% to 40%
National targets in OP have been maintained without increased resource despite 17% increase in OP referrals from 2013/14 levels
Patient and GP surveys have indicated high levels of satisfaction
Conclusion Implementation of CAS has streamlined patient management pathways and has had a significant impact on OP efficiency whilst providing cost savings to the health economy. 50% of patients now referred to GI are directed to a more appropriate and timely management pathway as opposed to attending traditional OP appointment. This has alleviated pressure on outpatient services resulting in reduced waiting times.
Disclosure of interest None Declared.
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