Can a Clinical Assessment Service CAS for routine

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 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 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.