PTH-17 The virtual referral triage clinic – A beneficial change in practice?

Published Date: 07th November 2021

Publication Authors: Priestley S, Liaros A

Introduction
Due to the COVID 19 pandemic gastroenterology elective activities were suspended in March 2020. When elective services were reinstated, social distancing imposed within the Trust resulted in a significant loss in traditional F2F (face to face) clinic capacity. A Consultant led Virtual Referral Triage Clinic (VRTC) was introduced with the aim to ensure ongoing patient care within the confines of the pandemic. Our objectives were to review of all non-2WW clinic referrals to determine and maintain appropriate, safe patient management whilst reducing hospital attendances.

Methods
A Gastroenterologist reviewed all non-2WW referrals within 24 hours of receipt of referral. VRTC sessions (4 hours) were provided 5 days/week. The potential outcomes of triage were: redirect to a more appropriate speciality, direct to straight to test (STT), discharge with ‘advice and guidance’ to the patient and/or GP and arrange a F2F appointment or telephone appointment (prioritised as urgent or routine). Data was collected in Excel and analysed.

Results
Above 1900 non-2WW referrals between 01/04/2020 – 31/10/2020 were received. Complete data was available in 1448 cases allowing detailed analysis. 88.9% of referrals were from primary care, the remainder from secondary care. Below are the VRTC outcomes. 9% were redirected to another speciality; 68% of those to colorectal or upper GI surgery. 38% were directed to a telephone clinic. 25.3% went STT, the majority for endoscopy, radiology and/or bloods tests e.g. parenchymal liver screen. 100 of the STT cases were reviewed; 79% were discharged or discharged as failed to attend their STT investigation. A total of 42.4% were redirected or discharged at triage or following STT investigations. Overall 86.3% of patients were managed without a ‘new’ patient F2F clinic appointment. This equates to approximately 155 F2F clinic sessions (8 patients/session). It required 105 VRTC sessions to complete work, therefore saved 50 clinic sessions.

Conclusion
The challenges include the ability to access enough information to enhance decision making at triage and the need to formalise in consultant job plans so that the process can continue. There is little evidence that neither patients nor GPs are significantly dissatisfied with this change in practice, with low rates of re-referral or complaint. It also does not appear patients come to harm or are mismanaged by this approach but may need longer term follow-up. There are obvious benefits: redirection of patients to more appropriate care, earlier diagnosis in those directed STT and a large reduction in unnecessary patient attendances with a subsequent significant reduction in the need for F2F clinic capacity.

Priestley, S; Liaros, A. (2021). PTH-17 The virtual referral triage clinic – A beneficial change in practice?. Gut. 70 (4), A179.

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