Author Joe Annandale, BSc, RN, is respiratory nurse specialist, Carmarthenshire NHS Trust, Prince Philip Hospital, Llanelli.
Abstract Annandale, J. (2008) How a nurse-led clinic cut outpatient waiting times. Nursing Times; 104: 9, 45. Joe Annandale describes how changing the respiratory nurse specialist role can improve outpatient waiting times and meet patients’ needs.
There is growing evidence of the effectiveness of nurse-led clinics compared with traditional medical models of providing healthcare (Pennery, 2003). Respiratory nurse-led clinics have been shown to be safe and effective (Sharples et al, 2002). Within the respiratory department at Carmarthenshire NHS Trust we realised that the knowledge and skills of the respiratory nurse specialist (RNS) were not being fully utilised and that the nurse’s skills could be used to help meet outpatient waiting-time targets.
Patients with a provisional diagnosis of asthma or COPD were selected from the respiratory physicians’ outpatient waiting list. They were sent an appointment with a letter stating an RNS would assess them. They were informed that this would speed up their assessment but, if they wished, they could decline the appointment and retain their place on the waiting list.
The assessment included a clinical history, general and respiratory examination and investigations. The provisional diagnosis was explained to the patient, with a focus on patient education and written information. The aim was to improve the patient’s awareness of their condition and promote self-management. Referrals were made directly to other health professionals where appropriate.
A typed summary was posted to the GP and the respiratory physician. This summary included recommendations on medication changes with the supporting rationale. Additional investigations were requested where appropriate. Findings and test results from each patient were reviewed with the respiratory physician to confirm or amend the management plan.
As no extra resources were available, the service was run on an ad-hoc basis. This meant that clinics were scheduled when the RNS had time and there was a room available in the outpatient suite.
Eighty-five patients were assessed over a period of 18 months. On average one clinic was held every three weeks. As the consultants only had the capacity to see five new non-urgent patients per week, this equates to a 17-week reduction in the waiting list.
Only 10 patients needed direct assessment by the respiratory physician, most were discharged back to their GP and a small number continued to be managed by the RNS.
After the initial six months an anonymous patient satisfaction questionnaire was posted to 35 patients with an 80% response rate. It found that 100% were satisfied that their condition had been explained to them and that they had an opportunity to ask questions. None of the respondents would have preferred to have seen a doctor. Patients were seen on time but 32% would have liked additional written information. Patient comments were all positive:
‘The respiratory outpatient clinic is such an important part of my treatment – everything is explained so well and clearly, and I feel at ease to ask worrying questions, which is a big comfort and relief to be able to discuss issues and even ideas.’
‘ I am very satisfied with the nurse and others. I have learnt more with them about my health than with my doctors over the years.’
‘I found the nurse specialist very helpful and informative about my condition. I now understand my asthma a lot more and how to cope with it better.’
The clinic also provided a good learning opportunity for the RNS to discuss each patient’s diagnosis and management with the consultant. Patients were seen by the same health professional, resulting in continuity of care.
This service could be applied elsewhere but its success depends on the skills and knowledge of the nurse specialists, the flexibility and strength of the team, and the desire to change practice.
Pennery, E. (2003) Effectiveness and evaluation of nurse-led clinics. In: Hatchett, R. (ed) Nurse-Led Clinics: Practice Issues. London: Routledge.
Sharples, L.D. et al (2002) A randomised controlled crossover trial of nurse pracitioner versus doctor-led outpatient care in a bronchiectasis clinic. Thorax; 57: 8, 1038–1043.