Completing the clinical governance cycle in dietetic gastroenterology outpatients.

摘要

Background: To overcome high rates of non-attendance, inappropriate referrals and long waiting times, an audit was undertaken of a dietetic outpatients clinic for gastroenterology patients in 2003 and then repeated in 2007. The aim of the first audit was to identify referral source, types of patient, attendance rates and if dietary advice had a positive outcome. This study aimed evaluated changes since 2003. Method: The clinic diary was used to identify patients booked to attend in 2003 and 2007. Information was retrieved from the patient's record on source of referral, types of referral, waiting times, attendance rates and dietary goals achieved. The results were compared to determine if changes had improved service delivery. The data were analyzed in Microsoft Excel (2003) and the attendance rates were compared using chi-squared statistics. Results: There were 92 new patients in 2003 and 69 patients in 2007; data were obtained for n = 77 in 2003 and n = 55 in 2007. There was an increase in referrals from gastroenterologists (n = 31, 55%) in 2007 compared with 2003 (n = 23, 34%). Waiting times improved between the two audits with 44% being seen within 3 months in 2003 compared to 51% in 2007. Attendance rates improved by 30% when the two audits were compared and in both years 2003 and 2007 (p = 0.009), a positive outcome was recorded for the majority of patients who had completed their treatment episodes 78% and 63% respectively. Table 1 Types of patients referred to Gastroenterology clinic Type of referral20032007Irritable bowel syndrome 4 (5)12 (21)Inflammatory bowel disease15 (19)7 (12)Bariatric surgery011 (20)Pancreatitis13 (16)9 (16)Gastric surgery7 (9)1 (2)General GI28 (36)13 (23)Non-gastro10 (12)2 (3) Discussion: The literature on the audit cycle in dietetic outpatients is limited. The baseline results in 2003 lead to the production of guidelines and the subsequent audit in 2007 demonstrated an improvement in clinical effectiveness. There was incomplete retrieval of records for the 2007 audit that led to missing data. Conclusion: Guidelines for the clinic improved appropriateness of referrals and the focus of the clinic. The procedural changes have decreased non-attendance and improved waiting times for patients. The changes implemented have improved service delivery for the patients and maximised the resources available for a specialist clinic by effectively utilising the skills of a Specialist gastroenterology dietitian.