Transcript Andrea Smith

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 1st 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 Email 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 1st 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.