35 Enhanced Vetting of Urology Referrals in NHS Lanarkshire

Aim

There is an unmatched need for outpatient clinic appointments across all specialties in the NHS. We aimed to reduce unnecessary clinic appointments within the Lanarkshire Urology Department and thus allow timely access to outpatient appointments for newly referred patients with greater clinical need.

Method

Following a successful pilot in December 2018 all referrals to Lanarkshire Urology department underwent an enhanced vetting process by a consultant urologist with particular attention to:Detailed review of electronic records and imagingBooking of scans/ repeat blood tests prior to consultationsSignposting to more appropriate services such as the community continence clinic were indicatedWritten advice, with returned referrals giving clear guidance and evidence-based recommendations where appropriate

Subsequently 3 phases have been completed

Phase 1: June-December 2019.

Phase 2: June-December 2020.

Phase 3: January - November 2021

Results

Pilot and Phase 1

6.3% of referrals were clinically canceled with the referrer being sent case specific clinical advice. This increased to 9.5% in phase 1.

Phase 2:

There were 3012 outpatient urology referrals between June and December 2020.

762 patients were vetted as clinically canceled, an 87% increase from 2019, reducing the number of clinic appointments required by 25%.

Phase 3:

9634 patients were referred between January 2021 and November 2021, 15.8% (n = 1484) vetted as clinically canceled/ advised only. Furthermore, 548 patients were taken straight to test decreasing duplicate appointments.

Conclusions

We have recognized that vetting is a factor that, done well, can mitigate unmatched demand in outpatient services.