http://bmj.com/cgi/content/abstract/325/7357/213
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 Collections under
which this article appears: Liver,
including hepatitis and cirrhosis |
Quality improvement report
Jonathan Mitchell
Gastrointestinal Unit, Royal Cornwall Hospital, Truro TR1 3LJ
Correspondence to: J Mitchell, Institute of Liver Studies, King's College
Hospital, London SE5 9RS jonmitch@clara.net
Problem: Patients with jaundice require rapid diagnosis and
treatment, yet such patients are often subject to delay.
Design: An open referral, rapid access jaundice clinic was
established by reorganisation of existing services and without the
need for significant extra resources.
Background and setting: A large general hospital in a largely rural
and geographically isolated area.
Key measures for improvement: Waiting times for referral, consultation,
diagnosis, and treatment, length of stay in hospital, and general
practitioners' and patients' satisfaction with the service.
Strategies for change: Referrals were made through a 24 hour telephone
answering machine and fax line. Initial assessment of patients
was carried out by junior staff as part of their working week.
Dedicated ultrasonography appointments were made available.
Effects of change: Of 107 patients seen in the first year of
the service, 62 had biliary obstruction. The mean time between
referral and consultation was 2.5 days. Patients who went on to
endoscopic retrograde cholangiopancreatography waited 5.7 days on
average. The mean length of stay in hospital in the 69 patients who
were admitted was 6.1 days, compared with 11.5 days in 1996, as shown
by audit data. Nearly all the 36 general practices (95%) and the
30 consecutive patients (97%) that were surveyed rated the service as
above average or excellent.
Lessons learnt: An open referral, rapid access service for
patients with jaundice can shorten time to diagnosis and treatment
and length of stay in hospital. These improvements can occur through
the reorganisation of existing services and with minimal extra cost.
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