| Popis: |
Introduction Patients with stable cirrhosis require regular clinic review and surveillance for hepatocellular carcinoma with 6-monthly ultrasound and alpha-fetoprotein levels. We looked at the uptake and cost, environmental and clinical benefits of a new specialist nurse-led telephone clinic for patients with stable cirrhosis. Methods Patients with both an established diagnosis of liver cirrhosis and stable disease (no ongoing insult to liver, no episodes of decompensation within preceding 12 months) were offered a nurse-led telephone appointment in place of a face-to-face clinic appointment. Those that accepted were contacted by the nurse at a designated time, with a proforma used to structure the consultation and to organise further investigations. If recent investigation results or the patient themselves raised concerns, a subsequent face-to-face appointment was organised with a consultant rather than continued review in the telephone clinic. We measured service uptake and calculated and compared the costs of running a face-to-face clinic with that of a telephone clinic. Results A total of 1,110 appointments were scheduled between November 2014 and February 2020, averaging 302 appointments per year. This equates to a capacity of around 20 consultant-led face-to-face clinics per year. We calculated the cost of running 20 such clinics (staffed by a consultant, clinic nurse and clinic clerk) as being £7,730. Conversely, the cost of running a nurse-led telephone clinic equates to roughly £1,300 per year, resulting in an annual saving to the trust of around £6,500 through this initiative. Furthermore, a telephone clinic confers benefits to the patient as well. Per year, this clinic results in a saving of £10 on petrol and parking, around 5 hours of patient time and will reduce their carbon footprint by roughly 0.01 tonnes of carbon dioxide. Additionally, the use of a guidance-based proforma to structure the clinic should result in improved adherence to evidence-based guidelines. Telephone clinics also reduce costs for the trust by freeing up staff and clinic rooms and by increasing clinic capacity for complex hepatology patients undergoing active treatment requiring face-to-face appointments. From the patient perspective, negating the need to physically visit the hospital in person obviates their need to take time off work and, certainly, feedback has been positive and there have been no complaints from users of this service. Conclusions Our nurse-led telephone clinics have shown excellent uptake by patients, with no negative feedback received to date. These clinics provide a clinically sound, cost-effective method for following up stable patients with liver cirrhosis, with clear and multifaceted benefits for both the patient and the trust. |
