PTU-094 Improving new to follow-up ratios in a district general hospital gastroenterology service

Abstract

Introduction The NHS 5 year forward view emphasises the need to develop new models of care. In 2004 an audit showed our new (N) to follow-up (FU) ratio for patients attending the gastroenterology outpatient department (GOPD) at Princess Alexandra Hospital (PAH) was 1:2.52. Since then there have been changes in our service: 2 IBD clinical nurse specialists (CNS) have been appointed (providing telephone and nurse-led clinics); an irritable bowel syndrome (IBS) primary care pathway introduced, and an adhoc telephone service implemented to deliver test results and interim management. This service evaluation assessed the current N:FU ratio for patients attending GOPD at PAH to determine whether we now meet our Clinical Commissioning Groups (CCG) contract N:FU ratio of 1:1.24 and British Society of Gastroenterology (BSG) commissioning recommendation advice to have ‘efficient use of OPD services with low FU:N ratios e.g. 1:1 for patients excluding those with chronic disease (inflammatory bowel disease (IBD) and liver disease(CLD))’. Methods Data was collected for consecutive patients seen in GOPD from April 2016 for 3 months. Data collected included diagnosis (or symptom where a diagnosis not yet made), whether they were N or FU and the clinic outcome (discharged or FU). The N:FU ratio was calculated and compared with CCG and BSG targets. Results Total number of patients seen by doctors1,347 (593 N, 754 FUs). The N:FU ratio was 1:1.27. If the IBD and CLD patients were excluded (as per BSG) our N:FU ratio was 1:1.00. Commonest symptoms/diagnoses for N and FU patients are shown in Tables 1 and 2. Of N patients 26% discharged and 61% had FU. For FU, 30% discharged and 57% had FU. Others did not attend their appointment, or no outcome specified. Conclusions A significant improvement in N:FU ratio (1:1.27) since last audit in 2004 (1:2.52). CCG targets (1:1.24) were almost met and excluding IBD and CLD from N and FU figures the BSG target of 1:1 was met. We aim to implement other GOPD changes in order to achieve CCG targets and further improve patient flow. Options being appraised include a liver CNS (to provide a similar service to IBD), virtual IBD clinics, better use of direct-to-test pathways, nurse-led protocol-driven clinics (e.g. anaemia), and virtual review clinics.