Assessing the Feasibility of a One-Stop Approach to Diagnosis for Urological Patients

Abstract

Ann R Coll Surg Engl 2009; 91: 305-309 305Out-patient practice in the UK NHS and many other public funded health systems is under extreme pressure. The current system suits no-one: patients often wait weeks to be seen by a specialist and then even straightforward problems can take several visits to hospital over several more weeks to resolve. This is bad for patients as it is clinically dangerous; bad for hospital managers who are forced to spend far too much time managing the degree of failure and inadequacy rather than putting in place better systems of care; and bad for doctors who respond by overloading clinics, rushing consultations, and engaging in activity to 'beat the system' on a patient's behalf. These activities, although well-intentioned, are often flawed and inevitably fail many other patients.The problems seem to be endemic and previous attempts to deal with them have failed to deliver really significant improvements. Simply working harder seems unlikely to be the answer since lack of commitment is not the problem. Recruitment of extra consultants and nurses has made little impact since the processes of diagnosis and clinical management to which they have been recruited are so inefficient. In addition, waiting-list initiatives and the appointment of locums to see new referrals make little impact. In fact, it could even be argued that they generally Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple outpatient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes.

The one-stop clinic as the standard of out-patient care in a hospital urology department

“…echography, cystoscopy, elemental urinalysis), such as benign scrotal enlargement, male sexual dysfunction, urinary tract infection and bladder filling disorders, were mostly managed in a single visit. Similar results have been published elsewhere (6). Experiences in the field of cardiology have also resulted in excellent percentages of patients diagnosed and discharged after a single visit (7).…”

“…The benefits for users seem clear: less appointments to gain a diagnosis, relationship with a single urologist, and avoiding the anxiety related to the delay of a firm diagnosis (6,8,9). Another intangible social benefit of the 'one-stop' approach is increased accessibility.…”

Referral and management options for patients with chronic kidney disease: perspectives of patients, generalists and specialists

“…Again, this is an option consistent with UK clinical guidelines and also supported by the specialists' view that discharge to generalist care could be more proactive. Evidence from urology further suggests that ‘one stop’ specialist review can be effective for clinical management …”

A One‐Stop Approach to the Management of Soft Tissue and Degenerative Musculoskeletal Conditions Using Clinic‐Based Ultrasonography

“…One‐stop clinics were introduced to streamline the assessment, investigation and treatment of patients through use of a single hospital visit. This approach has been proven to reduce delays, increase safety, be more cost‐effective and improve patient satisfaction (Coull et al., 2009). Many specialist breast clinics perform the triple assessment of examination, ultrasound and biopsy in one visit (Whitehouse et al., 2001).…”

“…Ear, nose and throat department‐led one‐stop clinics manage head and neck lumps in accordance with National Institute for Health and Clinical Excellence (NICE) guidelines on improving cancer care (Witcher et al., 2007). A series of nine urology one‐stop clinics in one study attended by 257 patients saved an estimated 350 appointments and 550 patient visits to the hospital (Coull et al., 2009).…”