Impact and cost-effectiveness of formal gastroenterology outpatient referral Clinical Assessment Service

ObjectiveThe aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.DesignAn electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed, and all data were analysed retrospectively.SettingRoyal Wolverhampton NHS Trust.Patients14 245 general practitioner (GP) referrals were received during January 2014–December 2016 with 9773 of them being triaged via our CAS.Main outcome measuresWe looked into patients’ clinical outcome along with departmental performance and finances.ResultsA new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of £481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%.ConclusionsOur clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.