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Ann R Coll Surg Engl ; 91(4): 305-9, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19344549

RESUMO

INTRODUCTION: 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 out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS: A total of 330 consecutive patients referred to the urology department of Guy's and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS: Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS: A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow-up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.


Assuntos
Assistência Ambulatorial/organização & administração , Ambulatório Hospitalar/organização & administração , Doenças Urológicas/diagnóstico , Unidade Hospitalar de Urologia/organização & administração , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Agendamento de Consultas , Análise Custo-Benefício , Estudos de Viabilidade , Humanos , Londres , Ambulatório Hospitalar/normas , Ambulatório Hospitalar/estatística & dados numéricos , Satisfação do Paciente , Unidade Hospitalar de Urologia/normas , Unidade Hospitalar de Urologia/estatística & dados numéricos
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