Nurse-led development of a rapid-access clinic and referral pathway for suspected inflammatory bowel disease

Inflammatory bowel disease (IBD) can have a similar presentation to irritable bowel syndrome, microscopic colitis and other differential diagnoses. Making a diagnosis is complex and typically involves multiple stages, including faecal calprotectin (FC) testing. In 2016, a rapid-access clinic and referral pathway for suspected IBD was developed by an IBD clinical nurse specialist to decrease the time from referral to diagnosis, reduce emergency admissions and outpatient referrals and improve patient experience. Over an 18-month period, a retrospective quantitative evaluation of 400 patients and small survey of 10 patients confirmed that the rapid-access clinic had had a positive impact on outcomes and that the service was sustainable. The results also led to a revision of the referral pathway, which raised the initial FC cut-off point and provided additional information for primary care professionals. This led to a small increase in the proportion of referrals that led to an IBD diagnosis, from 28% to 32%. The rapid-access clinic demonstrated the value of service development led by IBD nurses.

Consultant-led triage of paediatric hospital referrals: a service evaluation

ObjectiveWe established a paediatric demand management (PDM) service in our paediatric department in 2017. The aim of this consultant-delivered service is to manage referrals more efficiently by providing active triage of all referrals, daily rapid access clinics and easily accessible advice for primary healthcare professionals. This study presents an evaluation of this service.DesignMixed-methods service evaluation with analysis of data for every contact with the PDM service over a 2-year period. For each patient, the method of contact, reason for contact, presenting complaint and triage outcome were recorded. Feedback from general practitioners (GPs) and patients was gathered.ResultsData were analysed for 7162 patients. More than a quarter (2034; 28%) of all referrals were managed with advice only. Of the 4703 outpatient clinic referrals, 1285 (27%) were managed without a clinic appointment. More than half (54%) of the requests for paediatric assessment unit (PAU) admission were managed alternatively, typically with advice only or a rapid access clinic appointment. This has reversed the increasing trend of PAU admissions from primary care of preceding years. Financial analysis suggested the avoidance of these clinic appointments, and PAU admissions provided a substantial cost saving.ConclusionsOur results indicate that the PDM service has succeeded in reducing unnecessary hospital attendances by managing patients more effectively and strengthening partnerships with primary care. The service has received overwhelmingly positive feedback from GPs. This service could be replicated in other Trusts and developed in the future to facilitate further management of paediatric cases in a primary care setting.

Patient Satisfaction with Colorectal Rapid Access Clinic

Aims: Patients referred with red flag colorectal cancer symptoms are seen within 2 weeks of referral and require completion of treatment within 62 days of referral. The demand on resources is such that the remit of this rapid access pathway (RAP) is to diagnose or exclude cancer quickly. It is hypothesised that patients on these pathways are less likely to have their symptoms addressed and more likely to be dissatisfied with the service received. Study Design: Questionnaire based study of all patients attending new colorectal outpatient appointments, both routine and RAP. Place and Duration of Study: All patients referred the colorectal department at West Suffolk Hospital, a district general hospital, during January 2018 were sent a questionnaire 6 months later. Methodology: Results were analysed for statistically significant differences between the two groups in relation to patient satisfaction. Results: Of 273 new patients, questionnaires were returned by 78 patients attending rapid access clinics and 61 attending routine new appointments. There was no significant difference in the overall level of satisfaction with the overall investigation and management process between patients seen in rapid access clinics or routine new appointments (P = 0.867). Patients on the RAP were less likely to have been given a diagnosis (p = 0.001) or advice on managing their symptoms (P = 0.002). When assessing a number of variables, only patients whose symptoms had resolved were significantly more satisfied with the overall care pathway (P = 0.037). Conclusion: Patients seen on the RAP are not less satisfied with their care.

Rapid access clinics: Improving the efficiency of referral after discharge from the Emergency Department

Background: Rapid access clinics are an increasingly common model of care in tertiary hospitals. Early streaming of suitable patients to appropriate clinic services could reduce Emergency Department overcrowding. This study set out to investigate the current utilisation of rapid access clinic dispositions in a tertiary centre. The findings have led to useful mapping of local services and early nurse led identification of patients suitable for streaming to clinic locations. Methods: A cross-sectional observational study in a tertiary centre. Complete lists of consecutive discharged Emergency Department patients were generated by a trained data manger. Individual electronic medical records were reviewed for evidence of clinic disposition, patient demographics and compared with concurrent Emergency Department patients who were not referred. Results: 1367 patients included from 144 h of consecutive weekday presentations. Referral to clinic locations occurred in 179/1357 (13.2%) with rapid access clinics utilised in 129/179 (70.4%). No difference in median length of stay was observed for patients referred to clinics (3.9 h) versus patients not referred (3.8 h) (p = 0.29). Conclusion: In a tertiary Emergency Department setting, discharged patients were frequently referred to rapid access clinics. Early streaming to suitable outpatient locations may be an additional strategy to consider for mitigating Emergency Department overcrowding.