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  • Title: Outpatient general surgical follow-up: are we using this resource effectively?
    Author: Gurjar SV, Kulkarni D, Khawaja HT.
    Journal: Int J Surg; 2009 Feb; 7(1):62-5. PubMed ID: 19095510.
    Abstract:
    BACKGROUND: Raised patient expectations and the 2-week rule for the investigation of suspected malignancy have led to heightened demands on surgical outpatient clinics. In this context, the utility of benign post-operative or investigative follow-ups requires justification. METHODS: The surgical outpatient clinic workload of four substantive general surgeons at a typical DGH was analysed over a 4-week period. All notes were examined to identify referral source, management plan and whether that clinic attendance was justified. RESULTS: Twenty three clinics (410 patients) were examined over the period of this study. Three hundred and twenty one patient episodes were examined; 52 episodes did not occur due to patient non-attendance and 37 episodes were not accounted for ('missing/incomplete data'). Thirty three percent of the patients underwent consultant review whilst 57% were reviewed by middle grade surgeons and 9% by SHO/ST2 doctors. Forty eight percent of the consultations were new referrals: 37% of these patients were added to the elective surgical waiting list. One hundred and sixty eight follow-up consultations occurred, which included cancer patients (6%), review patients (12%), patients attending for investigative results (13%) and benign post-operative follow-ups (22%). Forty six of the 69 (66%) post-operative follow-ups were deemed unnecessary as patients were being seen after benign procedures (hernia repair, anorectal surgery or laparoscopic cholecystectomy). CONCLUSION: Over 50% attendances (21/41) for 'normal' results could have been avoided by the use of a directed informative letter. Outpatient clinics are an important resource whose usage must be optimised.
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