Lesson of the Week: Consultants' workload in outpatient clinics

Armstrong, David; Nicoll, M. F.

doi:10.1136/bmj.310.6979.581

Cited by 15 publications

(12 citation statements)

References 3 publications

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“…The problem of long waiting-list times clearly involves the whole system, ie both primary and secondary care, and this must be recognised if improvements are to be made. 19,30,31 In their study of dermatology clinics in Newcastle, Appleby and Lawrence involved local GPs, managers and health authorities, together with clinic medical and nursing staff in a process of change. This entailed reorganising the patient pathway, maximising specialist nursing skills, and implementing a demand management policy, agreed with GPs.…”

Section: Managing the Waiting Timementioning

confidence: 99%

Medical outpatients: changes that can benefit patients

Dunnill

Pounder

2004

Clinical Medicine

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-This article reviews the current literature relating to medical outpatient services. It has been produced as part of the RCP/NHS Confederation working party on outpatients departments. The article deals with surveys of patient views on outpatients, suggested ways of improving the service, and how best to accommodate teaching in this setting. An RCP booklet, 'How user friendly is your outpatient department?', has also been produced and is available from the college. KEY WORDS: ambulatory care, appointment, booking, clinic, outpatient, waiting timeMost physicians spend a significant part of their week working in the outpatient department but although the consultation in the outpatient clinic is an important part of patients' hospital care, it is traditionally an under-resourced area of the hospital. There has been little research into improving the service and, as a result, the experience for patients is not always as good as it should be.A well-run clinic will not only improve the experiences of patients but also the working lives of clinic staff. It may reduce the need for admission to hospital, both for disease control and for its investigation. 1 There is currently also political pressure for change, particularly regarding waiting times. The Government has recently issued a target of a maximum of three months wait for all outpatients' appointments by 2005. 2 This article reviews the literature relating to outpatients, with a focus on medical outpatients. The Working Party's aim was to develop recommendations to enable physicians to improve the experience for patients attending their clinics, and the work culminated in the publication of a booklet for health professionals. 3 Inevitably, in this paper there is some overlap with managerial issues (for example, direct booking systems or computer referral systems), and while some of these are beyond the scope of this article, they are addressed where physicians will be expected to work with managers to improve service delivery. Search strategyThe bibliographic databases Medline and Embase were searched for articles on outpatients, hospital outpatient clinics, outpatient departments or ambulatory care. Papers on day care were excluded. The results were limited to the UK, to the years 1966-2002 and to papers in English with abstracts available. Surveys of patient attitudes and satisfaction Waiting time and appointmentsLong waits for a first outpatient appointment are a common cause of patient dissatisfaction. However, one survey of a gastroenterology clinic showed that patients placed a similar value on waiting time for investigation and waiting for the first appointment: 4 a clinic that had a two-month wait for appointment, but offered immediate investigation was preferable to one with a two-week wait for appointment but a three-month wait for investigation. The authors suggest that to focus just on 'wait to first appointment' is too simplistic and does not take account of patient preferences.The length of time patients have to wait in the clinic before ...

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Section: Managing the Waiting Timementioning

confidence: 99%

Medical outpatients: changes that can benefit patients

Dunnill

Pounder

2004

Clinical Medicine

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“…EDITOR,--David Armstrong and Mick Nicoll suggest that the number of outpatients seen per hospital doctor and whole time consultant equivalent declined steadily from the inception of the NHS in 1949 until 1991 1. The implication seems to be that there are increasing inefficiencies in the hospital sector and that the present push for more consultants in service may be necessary.…”

Section: Not All Specialist Groups Hold Outpatient Clinicsmentioning

confidence: 99%

Consultants' workload in outpatient clinics

Volans

1995

BMJ

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“…EDITOR,--We wish to suggest an alternative interpretation of the data presented by David Armstrong and Mick Nicoll 1. During the 20 years 1971-91 the rate of increase in the numbers of general practitioners and consultants was similar (their figure 1).…”

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confidence: 94%