N018 Proactive triaging of new patients into outpatient clinic improves outcomes at the Royal Adelaide Hospital Inflammatory Bowel Disease Service
R. Grafton*1, J. Hughes1, L. Cronin1, J. Andrews1, 2
1Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, Adelaide, Australia, 2University of Adelaide, Adelaide, Australia
Inflammatory bowel disease (IBD) is a disease where flares can be debilitating and early treatment decisions critical to outcome. Many patients present to a gastroenterology consult with a complex medical history. Referrals often lack detail required to make clinical decisions and result in time consuming and often inaccurate patient recall. The Royal Adelaide Hospital Gastroenterology clinic oversees a patient group of approx. 900, growing by > 150/year, with one-third of patients travelling long distances from rural areas. New patient wait times are in excess of 3 months. Inappropriate booking/non-attendance is common and wasteful of appointments. Historically, triage into urgency categories was done by Gastroenterology trainees and allocated by clerical staff across 3 gastro clinics to any clinician within the department independent of IBD expertise. We sought to make better use of appointments and improve clinical outcomes for IBD patients.
In 2011, a senior gastroenterologist with IBD expertise began triaging new clinic referrals, enabling identification of known/potential IBD patients. IBD referrals were given to IBD specialist nurses to source missing clinical information from referrers/patients and book. Patients were sent IBD service details, a welcome booklet, medical history form for return, and, where necessary, faecal calprotectin and blood request forms for disease assessment and drug levels. Absent procedural reports; imaging/endoscopic/surgery were sourced. Patient contact details were confirmed. The nurses began overseeing all IBD bookings. Inappropriate/avoidable bookings were identified and changed, freeing up slots. Where urgency dictated need, routine reviews were rescheduled. New patients were now allocated only to a specialist /IBD trainee with an IBD interest in an IBD specific clinic.
A centralised booking system by trained clinicians has ensured bookings as clinically directed, allowed fast tracking, and highlighted avoidable appointments. The initial appointment is not ‘wasted’ instigating investigations as information for clinical decision making is already available. Treatment is commenced sooner. Prior knowledge of the IBD helpline provided advance medical advice. Wait time for urgent new bookings is < 6 weeks. Travel is reduced. Comfort levels and assistance have improved for adolescent families transitioning from paediatric care. Time critical handover of often demographically mobile ‘biologically’ treated patients, has been streamlined.
Small changes to the triaging of new patients, though requiring initial input and time by a senior gastroenterologist and nurse specialist, have yielded clinical benefits to patients and ensured best use of precious clinic slots.