Give the patients the choice—The ‘walk in walk out’ hernia clinic

Abstract

Background Patients referred with symptomatic inguinal hernias traditionally make at least three visits to the hospital and wait on average 41–53 weeks for their operation. Approximately, 10–15% of patients either do not attend (DNA) their clinic appointment, attend on the day of operation or are cancelled by the hospital due to bed shortage, lack of theatre space or associated co-morbidities. This results in a significant psychological strain on the patients and a financial drain on NHS resources. Aims To set up a hernia service within the confines of the NHS and give patients the choice of having their hernia repaired under local anaesthetic with only one visit to the hospital, on a date of their choosing, as in private hernia centres but without incurring the cost. Patients and Methods An e-mail containing two detailed proformas, “suitability criteria” and “instructions for patients” was sent to each general practitioner (GP) referring hernia patients to the North West London Hospitals NHS Trust (Northwick Park and Central Middlesex Hospitals). The GP gave each suitable and willing patient the instructions booklet and faxed a referral letter to the consultant's (RPB) scheduler. Patients were advised to read the instruction booklet and, when ready, ring the scheduler to make an appointment for a date of their convenience for the consultation and operation at the same visit. Results Ninety patients have been referred to the ‘walk in walk out’ (WIWO) clinic in the last 6 months. Ninety one percent of these patients have had successful ‘tension free’ open mesh repair under local anaesthetic. There were five (6%) inappropriate referrals (recurrent or bilateral hernias), and three patients (3%) did not attend their appointment due to ill health or family bereavement. Conclusion Patients with unilateral primary reducible inguinal hernias, regardless of their ASA status can safely have open ‘tension free’ mesh repair under local anaesthetic on a date of their choosing by making just one visit to the hospital. In just 6 months this ‘WIWO’ hernia clinic has shown a high level of patient satisfaction, significant reduction in ‘did not attend’/cancellation rates and financial savings for the Trust. Similar clinics set up across the nation would multiply the benefits we have shown.