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Driving down STD testing times

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Having to wait to be tested for a sexually transmitted disease (STD) can be a very anxious experience for patients. But an innovative service introduced at Southend Hospital?s genito-urinary medicine (GUM) department has proved hugely successful in reducing waiting times and boosting patient satisfaction and attendance

The clinic operates on three tiers: First, there is a doctor-led service for patients with complex pathologies or those presenting with symptoms such as abdominal, pelvic or testicular pain or a temperature, as well as patients who are pregnant or under 15 years old.

Then there is a nurse-led clinic, set up by clinic manager, Alison Keefe. Band 6 nurses used 36 patient group directives to treat conditions such as gonorrhoea and chlamydia and give vaccines against hepatitis A or B. They also take patient histories and decide what, if any, follow up is required.

Although many GUM departments around the UK offer these two types of service, it is the third ‘tier’ of Southend Hospital’s GUM service - the ‘quick check’ clinic - that sets it apart and makes it particularly innovative.

The quick-check clinic is an HCA-led clinic introduced to meet the 48-hour maximum wait target. In three years the numbers of new patients had risen from 4,000 to almost 6,500. The clinic, the brainchild of GU consultant Dr Henna Jaleel, is designed to treat the ‘worried well’ and those who are asymptomatic but want a sexual health check. An HCA performs the blood test and directs patients to ‘self-swab’ or provide urine samples as appropriate, so that they can be tested for the ‘big four’ STDs - chlamydia, HIV, gonorrhoea and syphilis.

‘Patients read an information leaflet and fill out their own form - there is no history taking and no examination,’ explains Alison. ‘The patients do their own swabs and the HCA takes a blood sample. This means the patient usually walks in and out of the clinic in 10 to 15 minutes.’

Anyone who does in fact have symptoms is transferred to one of the other tiers and seen on the same day; and patients who do not hear from the hospital within two weeks know their tests have been negative. However, the form they sign gives permission for the clinic to contact them if they require a follow-up.

In the first three months of being set up, 331 patients attended the quick check clinic (177 men and 154 women). Of those, 27 were found to have chlamydia, six had gonorrhoea and one syphilis, with the remainder all healthy.

The clinic was recently extended from three days a week to four and a patient satisfaction survey has confirmed the initiative’s success. The overwhelming majority of patients (96%) rated the service as excellent, and found being able to take their own sample without the need for a formal examination a very welcome development.

Alison believes that it is not only funding that is being used more efficiently as a result of the three-tier approach. ‘It fully utilises the skills of everyone in the clinic. The HCA has a wonderful opportunity to run her own clinic.’

The clinic has also developed what Alison calls a ‘hybrid’ role or HCA/receptionist.; ‘If someone is off sick the service doesn’t fall apart. It also means triaging by reception works well as they are better equipped with the knowledge needed to place patients in the right channel.’

Before February (2006), although urgent patients were always seen straight away, the waiting list for non-urgent patients was six weeks. Now all patients are seen within 48 hours and can usually be seen even if they just turn up.

Alison believes there is no reason why other GUM clinics around the UK cannot follow suit - as long as they have facilities to carry out polymerase chain reaction (PCR) tests. Many labs have been upgraded to this facility since the launch of the government’s National Chlamydia Screening Programme in 2002. ‘The beauty of the quick check clinic is that it is a transferable service. It can be used in family planning and primary care.’

The service has been recognised by Medfash - the Medical Foundation for Aids and Sexual Health - a government organisation that tours GU clinics around the country. As a result, Alison made a presentation to the Barts and the London Hospital NHS Trust - the trust is now planning to launch its own quick check clinic in December [2006]. ‘We are pleased that we have had a good idea that we can pass on to other services around the country.’

For more information on setting up a quick check clinic, email Alison Keefe at alison.keefe@southend.nhs.uk

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