Can a Clinical Assessment Service (CAS) for routine adult Gastroenterology referrals provide a clinically safe, sustainable, more efficient service that improves the patient experience

Background

What were the issues? Long waiting times for 1 st outpatient appointment (approx. 11 weeks) High DNA rate (approx. 11%) Avoidable test result feedback appointments Confusing referral process for GPs. Anecdotally – significant number of patients that could be managed in primary care Need to streamline pathways Desire to improve patient experience

Evidence Base

Woodward and Webb (2001) data extraction framework Initial searches produced little evidence Similar pilot projects undertaken in US (Baron et al, 2004) and Canada (Novak, Veldhuyen Van Zanten, Pendharkar, 2013) Study on triage for Neurology referrals (Patterson, Donaghy, Loizou, 2006)

Project Overview

Pilot project overview All referrals reviewed by a consultant gastroenterologist – dedicated time Reduce waiting times for 1 st outpatient appointment Reduce overall length of patient pathway Reduce number of unnecessary hospital appointments

Key steps Primary and secondary care clinicians working together Communications More streamlined pathway for patients

Project Evaluation

Service went live in January 2014 Evaluated in September 2014 Evaluated both with Data and Patient/service user questionnaires

Data Evaluation 2007 patients had been referred to the service 27% of patients did not require a first outpatient appointment Waiting times had reduced from 11 weeks to 6 weeks DNA rate had reduced from 11% to 4% Overall cost saving for 8 months was £88,025

Qualitative evaluation 80% of GPs found the process easy to use 81% of patients were satisfied with the information given and the outcome Feedback has only been sought by those who actually attended an appointment.