Introduction In 2012–13 gastroenterology (GI) services at Royal Wolverhampton NHS Trust (RWT) faced a 25% increase in new outpatient GI referrals. Therefore we collaborated with the Wolverhampton CCG to develop “Clinical Assessment Service” (CAS); a new model of working to improve efficiency of our GI referral pathways and reduce total costs to the healthcare economy whilst delivering an improved service to our patients. CAS allows secondary care clinicians to triage patients referred by GPs to the most appropriate pathway in a timely manner. We now present data from the first 3 years of the Gastroenterology CAS triage system at RWT.
Method An electronic CAS proforma and a data platform were developed. Five potential outcomes were identified for each patient. Pathways for the 5 most common referral indications were also introduced. Satisfaction surveys for GPs and patients were performed after the first year. Data were analysed retrospectively focusing on patient outcome decision and impact on departmental performance and finances.
Results A total of 14245 GP referrals were received between January 2014 and December 2016 with 9773 of them being triaged via our CAS service. A new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients either as a fast track, urgent or routine slot with 23.8% (n=2326) of them having bloods arranged prior to their appointment. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another GI clinic appointment. The remaining 21.3% (n=2089) of this group were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged to primary care with a letter of advice while 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. For the 3 year period of delivering the service this corresponds to 446 new outpatient clinics and estimated financial savings to health economy of £331K. 18 week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5% post CAS implementation.
Conclusion 32% of CAS triaged patients were discharged in primary care with letter of advice without need of GI appointment which corresponds to savings equal to £331K. DNA rates were low and patients’ feedback very positive. Through our experience with CAS we are able to demonstrate that our new model of clinical assessment for GI referrals has in addition to the clinical benefits, a considerable positive financial impact to the health economy.
Disclosure of Interest None Declared
- Gastroenetrology referrals
- outpatient clinics
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