Rheumatology 2003; 42: 1269-1270
© 2003 British Society for Rheumatology
Letter to the Editor |
Out-patient workload
Academic Rheumatology Unit, University Department of Clinical Medicine, Bristol, Avon, UK
Correspondence to:
J. R. Kirwan, University of Bristol Academic Rheumatology Unit, British Royal Infirmary, Bristol B52 8HW, UK. E-mail: john.kirwan{at}Bristol.ac.uk
SIR, Stimulated by the report from Dr Sathi and colleagues [1], I have looked again at the data from our regional out-patient survey [2] and reclassified the patients referred by general practitioners as far as possible according to their ‘clinical’ prioritization categories A, B and C. (It is likely, because of the differences in our data recording, that category C is overestimated and category B underestimated, although category A should be very similar.) The mean and median new patient waiting times (in days) for each category are compared with those of Sathi and colleagues in Table 1. Clearly, in one way or another, rheumatologists in the south-west of England do prioritize their patients, but all the waiting times are much longer. Would Sathi’s very reasonable solution to prioritizing patient referrals help here?
|
Sathi’s category A patients use up only 8% of all the patient waiting time. If we changed the distribution in the South West to match Lancashire, then category A patients wait 26 days, but category B patients wait 190 days and category C wait 97 days. (I guess, as B and C have about the same numbers in the South West, we could swap them over.) If we insist on category A waiting only 14 days and distribute the rest of the waiting proportionately among categories B and C, then category B will wait 140 days and category C 162 days. Readers will note that the current government target for new patient waiting is 13 weeks (91 days).
How can Lancashire deliver a well-ordered, prioritized service but the south-west of England cannot? In Lancaster in 1990, 28.8% of new patients had polyarthritis [3]. In 1994 the proportion in the south-west of England [4] was 37.0% and in 1988 the proportion at our rheumatology unit [5] was 42.8%. These differences in referral rates have a profound effect on how a service can be developed [6]. In particular, polyarthritis generates many follow-up appointments and fills up the out-patient clinics. In the south-west of England there are just not enough rheumatologists to meet the needs of the population.
We can do two things. The first is to lobby for more resources, and the second is to find new ways of working that allow us to treat patients more efficiently. The long-term follow-up of patients with rheumatoid arthritis is the single biggest demand on rheumatology out-patient services [2], and work is progressing on ways to make this both less demanding and more effective [7, 8].
References
- Sathi N, Whitehead E, Grennan D. Can a rheumatologist accurately prioritize patients on the basis of information in the general practitioner referral letter? Rheumatology 2003;42:000–000
- Kirwan JR, Averns H, Creamer P et al. Changes in rheumatology out-patient workload over 12 years in the South West of England. Rheumatology 2003;42:175–9
[Free Full Text] - Halsey J, Peebles A. Rheumatology referrals to a district general hospital. Br J Rheumatol 1991;30(Suppl.2):104
- Kirwan JR for the former South West Regional Advisory Committee for Rheumatology. Rheumatology outpatient workload increases inexorably. Br J Rheumatol 1997;36:481–6
[Abstract/Free Full Text] - Stellakis M, Cooper C, Kirwan JR, Snow S. General practitioner referrals to a rheumatology unit. Br J Rheumatol 1990;29:237–8
[Free Full Text] - Kirwan JR. Referral patterns. In: Haslock I, Pitzalis C, Reeves B, Shipley M, eds. Key advances in the effective management of rheumatoid arthritis. London: Royal Society of Medicine, 2001:13–17
- Hewlett S, Mitchell K, Haynes J, Paine T, Korendowych E, Kirwan JR. Patient-initiated hospital follow-up for rheumatoid arthritis. Rheumatology 2000;39:990–7
[Abstract/Free Full Text] - Kirwan JR, Mitchell K, Hewlett S et al. Clinical and psychological outcome from a randomized controlled trial of patient-initiated direct-access hospital follow-up for rheumatoid arthritis extended to 4 years. Rheumatology 2003;42:422–6
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||