Variation in waiting times by diagnostic category: an observational study of 1,951 referrals to a neurology outpatient clinic

Abstract

ObjectiveTo investigate the frequency of diagnoses seen among new referrals to neurology outpatient services; to understand how these services are used through exploratory analysis of diagnostic tests and follow-up appointments; and to examine the waiting times between referral and appointment.MethodsRoutine data from new National Health Service appointments at a single consultant-delivered clinic between September 2016 and January 2019 were collected. These clinical data were then linked to hospital administrative data. The combined data were assigned diagnostic categories based on working diagnoses to allow further analysis using descriptive statistics.ResultsFive diagnostic categories accounted for 62% of all patients seen within the study period, the most common of which was headache disorders. Following a first appointment, 50% of all patients were offered at least one diagnostic test, and 35% were offered a follow-up appointment, with variation in both measures by diagnostic category. Waiting times from referral to appointment also varied by diagnostic category. 65% of patients with a seizure/epilepsy disorder were seen within the 18-week referral to treatment target, compared with 38% of patients with a movement disorder.ConclusionsA small number of diagnostic categories account for a large proportion of new patients. This information could be used in policy decision-making to describe a minimum subset of categories for diagnostic coding. We found significant differences in waiting times by diagnostic category, as well as tests ordered, and follow-up offered; further investigation could address causes of variation.

Outpatient neurology diagnostic coding: a proposed scheme for standardised implementation

“…It is unrealistic to expect to implement a perfect system immediately, enabling complete coding of all patients. Indeed, it would be preferable that a system captures coding for 80% of all outpatients (new and follow-up) using a small number of codes than to Despite the widespread lack of outpatient coding and the adverse impact this had on recent COVID-19 risk stratification exercises, 8 those clinicians with locally held diagnostic category data benefited from more rapid identification of patients with diagnoses likely to be deemed extremely vulnerable (eg, conditions associated with bulbar dysfunction). There are likely to be many similar situations.…”

“…In order to determine a reliable estimate of diagnostic category frequencies, we combined the data from two large neurology referral studies 8 9 Table 1. shows the diagnostic categories and frequencies in the two studies, as well as the combined frequencies and combined proportions.…”

“…Despite the widespread lack of outpatient coding and the adverse impact this had on recent COVID-19 risk stratification exercises, 8 those clinicians with locally held diagnostic category data benefited from more rapid identification of patients with diagnoses likely to be deemed extremely vulnerable (eg, conditions associated with bulbar dysfunction). There are likely to be many similar situations.…”

Identifying variation in GP referral rates: an observational study of outpatient headache referrals

“…[12] Headache, including migraine, accounts for a large proportion of consultant neurologist appointments in the UK. [13][14][15][16][17] It has been reported that GPs refer up to 2 to 3% of the headache patients they see in primary care, [18] and that GPs experience pressure from patients to refer to specialist care. [19] This is despite the fact that headache conditions are often best managed at primary care level.…”

“…In a previous study we found that the majority of patients attending a neurology outpatient clinic had only one appointment. [16] Many of these appointments were for headache, with patients often discharged after only one appointment without investigation. Whilst we recognise that even a single consultation with a neurologist can make an important contribution to the patient's management, much of the advice given, particularly in relation to lifestyle factors and avoidance of medication overuse headache, could be delivered in primary care.…”