TBA (22W175)

Nurse-led virtual triage clinics improve outpatient access and reduce waiting times for paediatric gastroenterology care

Author(s)

Bríd Devery and Séamus Hussey

Department(s)/Institutions

National Centre for Paediatric Gastroenterology, CHI-Crumlin

Introduction

Children’s Health Ireland - Crumlin is Ireland’s sole paediatric tertiary GI, hepatology, nutrition and transplant centre, receiving referrals nationally from primary and secondary care sources. All referrals are actively triaged by consultants. Limited resourcing leads to delayed access to care, especially for less urgent and routine referrals which generate long-term wait-lists.

Aims/Background

This project aimed to reduce the waiting times of children on long-term waiting lists, and to identify patients in need of more priority access to care through a nurse-led validation and triage clinic.

Method

A nurse-led validation and triage (NLV) clinic was introduced in January 2021, funded by the National Treatment Purchase Fund. The CHI GI wait-list was assessed in chronological order from the ‘longest waiter’ to the most recent referral. The NLV clinics took place three times per week. Each child and parent were pre-scheduled by the administration team for a 30 minute consultation with the Clinical Nurse Specialist Practitioner (CNSp). Standardised questionnaires were developed by the CNSp to assess patients based on their clinical referral letters. Five consultation outcome categories were defined: suitable for discharge, additional investigations: blood test or stool sample; direct to endoscopy referral; GI consultant review (all <6 months) and referral to Emergency Department or Primary Care for urgent assessment. Children/adolescents who were categorised to the ‘Endoscopy/ colonoscopy’ outcome were discussed and referred to the endoscopy wait-list by the GI consultant. Children/adolescents who were categorised to the ‘Investigations’ outcome, received a follow up appointment within 8 weeks to review their blood/stool results and to determine their outcome.

Results

The GI department accepts a mean of 1000 referrals annually. A total of 385 patients were identified as ‘long-waiters’, including referrals waiting since 2016. Of these, 112 (29%) declined GI review and were discharged directly, while 273 (71%) still required NLV clinic review. The NLV clinic outcomes included discharge to primary care (35%), endoscopy referral (24%), consultant review required (35%) and 6% required further investigations. As of November 2021, all but 27 patients on the GI waiting list were within the HSE target waiting time category of <12 months.

Conclusions

Nurse-led validation clinics are a novel, cost efficient and effective approach to managing long waiting lists for outpatient access. Only 1:4 patients triaged still needed a consultant review, while other patients were better managed through direct endoscopy referral or clinically appropriate discharge. Nurse-led validation should be considered by other clinical services to improve access to care and prioritise patients in greatest clinical need.