B. Su’a1, A. Taneja1, A. G. Hill1 1The University Of Auckland,Department Of Surgery,Auckland, AUCKLAND, New Zealand
Introduction:
Outpatient specialist clinic appointments in the public health system face an increasing service demand. There is an emerging need for more efficient resource utilisation to ensure that waiting time targets are met. We present a novel remodelling of a rectal bleeding outpatient clinic aimed at improving efficiency by protocolising the management for patients with minor anorectal conditions.
Methods:
An evidence based protocol for the management of patients with minor anorectal conditions and outlet rectal bleeding was devised by the colorectal department at CMDHB in November 2013. A key feature was to utilise a Patient Initiated Follow Up system (PIFU) where patients are given a ‘card to call’ instead of being provided with routine follow up appointments. Patients were allocated to a new, once monthly ‘PR bleeding clinic.’ The control group was a historical cohort of sequential patients with minor anorectal conditions who had been seen by the colorectal unit prior to 2013.
Results:
68 patients were prospectively analysed in the new clinic from November 2013 to May 2014 and 80 patients were included in the historical group from December 2012 to February 2012. Baseline characteristics were similar. Whilst there was no significant difference in the overall rate of colonic investigations, CT colonography was more frequently utilised in the new clinic (26.5% vs. 8.8%, p=0.007). Patients in the new clinic were also more likely to receive haemorrhoid banding (39.7% vs. 13.8%, p=0.001), whilst elective surgery rates remained similar (11.8% vs. 15.0%, p=0.635). Routine follow up appointments were significantly less in the new clinic (4.4% vs. 48.8%, p<0.001). A PIFU card was given to 56 out of 68 patients in the new clinic. Nine patients called back, of which only 2 patients required further follow up appointments. The median duration of the follow up period was 176 days. Mean waiting time from time of original referral was 45 ± 20 days in the new clinic group vs. 99 ± 25 days in the control group (p<0.001).
Conclusion:
Protocolised management of patients with minor anorectal conditions reduces follow up of patients with minor anorectal conditions. This releases capacity to see new patients in a pressured public hospital outpatient clinic and can improve elective waiting times.