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One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

Gorman M, Coelho J, Gujral S, McKay A - Plast Surg Int (2015)

Bottom Line: The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average.This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction.We offer our considerations and local experience instituting an OSC service.

View Article: PubMed Central - PubMed

Affiliation: Castle Hill Plastic Surgery Unit, Hull HU16 5JQ, UK.

ABSTRACT
Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

No MeSH data available.


Related in: MedlinePlus

Three illustrative figures reflecting how effectively a department delivers care in relation to the 18 ww pathway. The first graph: (a) depicts an ideal negative “ski slope” shape curve, where the majority of referrals are seen and treated at the beginning of the pathway, implying that a department has adequate resource to cope with demand. This is opposed to a wider distribution in (b) or bimodal pattern in (c), with peaks at either side of the 18 ww threshold (or target) implying an unsuccessful attempt to rush through patients at the end of the pathway in order to meet target compliance (avoiding fines imposed by the NHS) rather than improve patient care, as is intended by the 18 ww. (a) Ideal “ski slope” curve. (b) Wider distribution, and (c) bimodal pattern implying a struggle to meet the demand of referrals.
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fig1: Three illustrative figures reflecting how effectively a department delivers care in relation to the 18 ww pathway. The first graph: (a) depicts an ideal negative “ski slope” shape curve, where the majority of referrals are seen and treated at the beginning of the pathway, implying that a department has adequate resource to cope with demand. This is opposed to a wider distribution in (b) or bimodal pattern in (c), with peaks at either side of the 18 ww threshold (or target) implying an unsuccessful attempt to rush through patients at the end of the pathway in order to meet target compliance (avoiding fines imposed by the NHS) rather than improve patient care, as is intended by the 18 ww. (a) Ideal “ski slope” curve. (b) Wider distribution, and (c) bimodal pattern implying a struggle to meet the demand of referrals.

Mentions: In relation to cancer, the importance of markers such as the 18 ww relates to evidence spanning the surgical specialities (including head and neck, general, breast, gynaecology, and skin/dermatology) indicating that rapid access to diagnosis and treatment decreases patient anxiety and has been associated with improved survival outcomes [8–13]. Previous studies, when measuring waiting time performance in relation to OSCs, have not done so against nationally agreed benchmarks, and whilst believing this is important, we acknowledge the 18 ww to be just one of the many targets instituted by regulatory bodies to promote shorter waiting times and that such thresholds will inevitably change over time [14]. Based upon work by the Cancer Service Collaborative “Improvement Partnership” (CSCIP 2006), surgical departments in the UK should see and treat ≥ 90% of outpatients (≥95% for inpatients) within the 18 ww [14]. The 10% leeway makes allowance for more complex or unforeseen patient scenarios, such that a service operating in a healthy fashion should have the capacity to see and treat the vast majority of patients in the first few weeks, not spread over the 18 ww pathway [15]. Plotted on a graph, an 18 ww curve should thus be shaped like a ski slope (Figure 1(a)) as opposed to a wide spread or bimodal pattern of distribution (Figures 1(b) and 1(c)) [16, 17]. Such patterns, alongside 18 ww target compliance, may aid the assessment of how a department is functioning (further explanation in Figure 1 caption).


One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

Gorman M, Coelho J, Gujral S, McKay A - Plast Surg Int (2015)

Three illustrative figures reflecting how effectively a department delivers care in relation to the 18 ww pathway. The first graph: (a) depicts an ideal negative “ski slope” shape curve, where the majority of referrals are seen and treated at the beginning of the pathway, implying that a department has adequate resource to cope with demand. This is opposed to a wider distribution in (b) or bimodal pattern in (c), with peaks at either side of the 18 ww threshold (or target) implying an unsuccessful attempt to rush through patients at the end of the pathway in order to meet target compliance (avoiding fines imposed by the NHS) rather than improve patient care, as is intended by the 18 ww. (a) Ideal “ski slope” curve. (b) Wider distribution, and (c) bimodal pattern implying a struggle to meet the demand of referrals.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4506812&req=5

fig1: Three illustrative figures reflecting how effectively a department delivers care in relation to the 18 ww pathway. The first graph: (a) depicts an ideal negative “ski slope” shape curve, where the majority of referrals are seen and treated at the beginning of the pathway, implying that a department has adequate resource to cope with demand. This is opposed to a wider distribution in (b) or bimodal pattern in (c), with peaks at either side of the 18 ww threshold (or target) implying an unsuccessful attempt to rush through patients at the end of the pathway in order to meet target compliance (avoiding fines imposed by the NHS) rather than improve patient care, as is intended by the 18 ww. (a) Ideal “ski slope” curve. (b) Wider distribution, and (c) bimodal pattern implying a struggle to meet the demand of referrals.
Mentions: In relation to cancer, the importance of markers such as the 18 ww relates to evidence spanning the surgical specialities (including head and neck, general, breast, gynaecology, and skin/dermatology) indicating that rapid access to diagnosis and treatment decreases patient anxiety and has been associated with improved survival outcomes [8–13]. Previous studies, when measuring waiting time performance in relation to OSCs, have not done so against nationally agreed benchmarks, and whilst believing this is important, we acknowledge the 18 ww to be just one of the many targets instituted by regulatory bodies to promote shorter waiting times and that such thresholds will inevitably change over time [14]. Based upon work by the Cancer Service Collaborative “Improvement Partnership” (CSCIP 2006), surgical departments in the UK should see and treat ≥ 90% of outpatients (≥95% for inpatients) within the 18 ww [14]. The 10% leeway makes allowance for more complex or unforeseen patient scenarios, such that a service operating in a healthy fashion should have the capacity to see and treat the vast majority of patients in the first few weeks, not spread over the 18 ww pathway [15]. Plotted on a graph, an 18 ww curve should thus be shaped like a ski slope (Figure 1(a)) as opposed to a wide spread or bimodal pattern of distribution (Figures 1(b) and 1(c)) [16, 17]. Such patterns, alongside 18 ww target compliance, may aid the assessment of how a department is functioning (further explanation in Figure 1 caption).

Bottom Line: The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average.This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction.We offer our considerations and local experience instituting an OSC service.

View Article: PubMed Central - PubMed

Affiliation: Castle Hill Plastic Surgery Unit, Hull HU16 5JQ, UK.

ABSTRACT
Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

No MeSH data available.


Related in: MedlinePlus