The new standard of care in urology outpatients? A one-stop clinic improves efficiency and quality

Abstract

Objective The objective of this article is to determine retrospectively if a one-stop clinic for all new urology referrals improved the efficiency and quality of our outpatient pathway. We considered any improvement in productivity (e.g. waiting times) to indicate improved efficiency as resources were not increased. We considered any improvement in the level and continuity of specialist care to indicate improved quality as these factors have both been associated with measures of quality such as patient satisfaction. Patients and methods Quality and efficiency markers were recorded and compared for 100 consecutive urology referrals from 1 October before (2010) and after (2011) introduction of the clinic. Efficiency markers recorded were waiting times, discharge rate, number of dictated letters and clinic attendance. Quality markers recorded were grade and continuity of specialist care. Results The new appointment wait dropped from seven to two weeks. The commonest tests (flexible cystoscopy and ultrasound) were virtually all completed at first attendance. Median hospital visits before diagnosis dropped from two to one (p < 0.001). The discharge rate rose from 5/100 to 19/100 (p < 0.001). More patients (72/100 versus 42/100) were seen by a consultant and more cystoscopies (23/25 (92%) versus 1/28 (3.3%)) were performed by the urologist requesting them (p < 0.0001). The median number of dictated letters per diagnosis dropped from three to two in the one-stop clinic (p = 0.002). Conclusion The one-stop clinic significantly improved efficiency and quality markers for all new referrals, thereby improving access and reducing inequality. The clinic was inexpensive to introduce, and wider adoption of similar clinics could improve access to urological care.

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes

“…there were no clinics that accepted referrals where there was a general suspicion of cancer. The indications for referral included: seven studies on post-menopausal or abnormal vaginal bleeding (20)(21)(22)(23)(24)(25)(26), six studies on breast symptoms (14,15,(27)(28)(29)(30), three for lower gastrointestinal (GI) symptoms (16,31,32), three for elevated prostate specific antigen (PSA) (17,18,33), three for testicular symptoms (34)(35)(36), two for urological symptoms (37,38), two for dyspepsia (39,40), one for haematuria (19), one for unexplained lymphadenopathy (41), and one for neck lumps (6). When reported, one-stop clinics were held in a hospital setting.…”

“…Based on the findings of this review, we are unable to comment on the risk of overdiagnosis in one-stop clinics: only one study reported patients diagnosed with asymptomatic breast cancer and most also had symptomatic breast cancer (29). Some authors considered the CR's for cancer and serious disease to be too low (30,39) whilst others concluded that testing more patients to reduce the risk of under-diagnosis was important (19,37). GPs will play a vital role in minimising inappropriate referrals to achieve a balance between under-and overdiagnosis.…”

“…One-stop clinics were associated with a significant reduction in the waiting time between referral and clinic appointment from a mean of 75 days (standard deviation (SD) 47 days) in multi-stop pathways (4 studies) to 15 days (SD 7 days) in one-stop clinics (9 studies) (r = 2.78, P = 0.005). Only one study reported the change in diagnostic interval and found a significant decrease from usual care clinics (28 days) associated with the one-stop clinic (15 days, P = 0.004) (37). Significantly more patients referred to one-stop clinics (79.2%) compared to multi-stop clinics (24.7%) were also diagnosed on the same day (r = −1.95, P = 0.05) (14 studies).…”

“…The gaps in the evidence should be addressed by studies heeding the shortcomings of previous research in this field. The studies that we assessed to be of higher quality were those that described a randomised trial rather than observational design (14), provided a full account of the patients that entered the study (14,17,23,30,36), and justified the statistical methods used (37). These are only a small proportion of the studies included in this review and this highlights the need for more, high quality studies that make use of prospective designs, randomisation of patients to one-stop and comparator groups, and rely less on clinical records data not collected for the purposes of the study.…”

“…There was less agreement about how one-stop clinics should be delivered. Some authors suggested cost savings could be made by using existing resources rather than investing in new facilities (37). Contrary to this, others stated that the difficulties which arose from patients having to navigate the hospital to attend different investigations meant that restructuring was necessary so that investigation, consultation, and administration could be carried out side by side (38).…”