RESUMO
INTRODUCTION: The traditional outpatient paradigm of seeing patients prior to diagnostic tests and treatment is unsustainable without additional funding. New models of service delivery such as "one-stop clinics", direct access to diagnostics and advanced nurse practitioner (ANP)-led clinics have the potential to improve the efficiency of existing services. METHODS: To determine the most effective changes to improve service provision, the reasons for encounter (RFE) to a urology clinic were assessed using the International Classification Primary Care. To test these changes, a clinical validation process was performed on existing waiting patients waiting ≥ 15 months. Direct access to diagnostics and an ANP-led clinic were introduced. The impact of this validation process was measured prospectively using independently-collated National Treatment Purchase Fund waiting list data. RESULTS: From January to December 2017, 1114 new patients were referred. The 3 most frequent RFEs were haematuria, urinary frequency/urgency and cystitis and accounted for 48% of referrals overall. A new outpatient pathway, combining direct access to diagnostics and an ANP-led clinic, was implemented on 508 existing patients waiting ≥ 15 months. The validation process resulted in referral directly to a consultant-led clinic in 36%, to an ANP-led clinic in 12%, direct access to diagnostics in 38% and removal in 13%. This change was implemented in July 2017 and there was a 76% reduction in the number of patients waiting ≥ 12 months by December 2017. CONCLUSION: New models of outpatient service delivery have the potential to reduce existing waiting lists and could be implemented in other Irish hospital groups.