Dr T Mathialahan and Jeanette Starkey
Betsi Cadwaladr University Health Board
Background
An audit in 2017 showed 20% of patients referred to secondary care gastroenterology services within BCUHB East were diagnosed with functional gut issues. There is currently a 144 week (784 patients) waiting list for routine gastroenterology patients, which continues to increase year on year. The urgent waiting list is 53 weeks (328 patients). Consultant Gastroenterology outpatient services at BCUHB East have had a 39% increase in outpatient referrals over the past 4 years; on top of this there is inadequate gastroenterology consultant staffing due to the inability to recruit with current staffing at 3 fulltime consultants and 1 part time consultant, instead of the recommended 6WTE consultants per 250,000 population. This has increased waiting times as above which has associated financial implications, negative impacts on quality of patient care as well as failing to meet targets set out by national standards for patient groups. Evidence shows that routine gastroenterology patients can be managed successfully in a First Contact Dietitian Led Gastroenterology clinic
Aims
- Reduce the number of non-urgent routine gastroenterology patients who are seen by gastroenterology consultants by triaging them to First Contact Dietitian Led Clinics
- Reduce the 3 year waiting list for non-urgent gastroenterology patients by offering appointments for assessment and management within the First Contact Dietitian Led Clinics.
- Reduce waiting times for secondary care gastroenterology consultant outpatient services overall – Enable consultants to see urgent or more complex patients timely reducing risk of admission and improving management plans for patient
- Provide a more streamlined, safe and effective pathway for the patient
Process
Triage and referral criteria were developed to enable the gastroenterology consultants to refer appropriate non-urgent gastroenterology patients to an ACP gastroenterology dietitian for initial clinical and dietetic assessment, diagnostics and appropriate management. This has been supported by robust pathways, protocols and scope of practice for clinical governance share across primary and secondary care.
Outcomes / Benefits
- 318 patients removed from secondary care waiting list
- 500 consultant appointment slots released
- 14% increase in gastroenterology clinic capacity
- £108,000 minimum cost release (consultant time)
- Routine functional gut waits reduced from 3 years to 4 months
- Most cases managed solely by ACP dietician through medication, lifestyle or investigation checks
- Gastroenterology consultants fully supportive of clinics
- 90% of patients scored the service as excellent, 10% – very good
What Next?
- Aiming to acquire permanent funding for this post
- Identified other areas of gastroenterology where pathways can be re-evaluated and improved with joint work between the gastro consultants, nurses and dietitian
- With support of Bevan Commission, look to promote adopt and spread of this role/service
- Publish work in journals to promote the work and feasibility of adopting and spreading such a service elsewhere
- Create ACP gastroenterology dietitian network to standardize competencies and job roles
