Porrett T R C, Lunniss P J
The Homerton Hospital, London, UK.
Colorectal Dis. 2004 Jul;6(4):268-74. doi: 10.1111/j.1463-1318.2004.00640.x.
The overburdening of colorectal out-patient clinics necessarily leads to delays in time from referral to consultation and subsequent clinic attendance. This study aimed to ascertain the feasibility of 'paper clinic' follow-up rather than all patients receiving a routine follow-up appointment following investigation. A more efficient outpatient follow-up process should reduce unnecessary follow-up, thereby facilitating the speedy investigation and diagnosis of patients through changes in clinic profiles.
From August 2001 all patients seen in the outpatient clinic of one (part time) Consultant colorectal surgeon, who required investigation, were prospectively recorded on a 'paper clinic' form. These patients were given the necessary test request forms but were not given a further outpatient appointment. The results of the investigations were reviewed, together with the patients' medical records at a formal fortnightly 'paper clinic' session carried out by the Consultant and Nurse Consultant, and a treatment plan derived. Patients then followed one of 5 follow-up pathways and were notified in writing with a copy to their GP.
During a 24-month period a total of 897 patients were reviewed using the 'paper clinic' follow-up system. Of these, 285 (31.8%) patients were discharged without further follow-up. In a given 3-month period when the clinic was well established, 152 patients were reviewed, of whom 27% were discharged from follow-up, 17% received SOS appointments, 13% required further investigation (and consequently were returned to 'paper clinic' follow-up), and 7% received Nurse led follow-up. In this 3-month period 64% of patients reviewed by 'paper clinic' follow-up did not return to Surgical Outpatient's and 12% received a Surgical Outpatient appointment for review.
'Paper clinic' follow-up is an effective and feasible follow-up alternative, resulting in a major decrease in outpatient follow-up burden. This has allowed the redesign of the outpatient clinic profile allowing for an increase in new urgent slots, and more rapid clinic follow up review of those patients who need it. Re-design and rationalization of existing services can result in considerable service improvement. Expanding clinics should not be considered the only option when faced with capacity and demand issues.
结直肠门诊负担过重必然导致从转诊到会诊以及后续门诊就诊的时间延迟。本研究旨在确定“纸质门诊”随访的可行性，而非让所有患者在检查后接受常规随访预约。更高效的门诊随访流程应减少不必要的随访，从而通过改变门诊病例情况促进患者的快速检查和诊断。
从2001年8月起，一位（兼职）结直肠外科顾问医生门诊中所有需要检查的患者均被前瞻性地记录在“纸质门诊”表格上。这些患者被给予必要的检查申请表格，但未获得进一步的门诊预约。在顾问医生和护士顾问每两周举行一次的正式“纸质门诊”会议上，对检查结果以及患者的病历进行审查，并制定治疗计划。然后，患者遵循5种随访途径之一，并以书面形式通知，副本发送给其全科医生。
在24个月期间，共有897名患者使用“纸质门诊”随访系统进行了审查。其中，285名（31.8%）患者无需进一步随访即可出院。在门诊运行良好的特定3个月期间，对152名患者进行了审查，其中27%的患者停止随访，17%的患者接受了紧急预约，13%的患者需要进一步检查（因此返回“纸质门诊”随访），7%的患者接受护士主导的随访。在这3个月期间，通过“纸质门诊”随访审查的患者中有64%未返回外科门诊，12%的患者接受了外科门诊复查预约。
“纸质门诊”随访是一种有效且可行的随访替代方式，可大幅减轻门诊随访负担。这使得门诊病例情况得以重新设计，增加了新的紧急预约时段，并能对需要的患者进行更快的门诊随访复查。对现有服务进行重新设计和合理化可带来显著的服务改进。面对能力和需求问题时，不应仅考虑扩大门诊规模这一选项。
