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76 Going with the flow: improving outcomes for inpatients with urgent gastroenterological issues by optimising for time to specialty
  1. John Wye,
  2. Chantal Izquierdo,
  3. Nuala Jennings,
  4. Ehab Abdelmalek,
  5. Monica Bose
  1. Princess Alexandra Hospital, UK


Aims To improve outcomes of patients with emergency Gastroenterology diagnoses through optimising ‘Time to Specialty’ using a Plan-Do-Study-Act (PDSA) approach.

Methods This outcome measure was initially identified from personal experience of some of the authors. To justify it we collected data on patients admitted with flares of ulcerative colitis in the past year and found a strong positive correlation between length of stay (LOS) and the amount of time a patient spent outside of our specialist gastroenterology ward (Pearson correlation coefficient=0.68). We shall refer to this latter measure as Time to Specialty, our outcome measure.

We identified key moments in a patient’s journey using a flow diagram and attempted to optimise them separately, measuring the effect on Time to Specialty. We identified teams involved in the admission and transfer process at each stage and engaged with them to collaboratively solve challenges. After talking to the relevant parties we created a solution that would impose a minimum of extra work as well as meeting the incentives of the different teams involved.

Results We received immediate positive feedback from the teams involved, who found that our electronic solution lifted some of the administrative burden from a pen-and-paper process. The data showed a marked improvement in the Time to Specialty for our urgent cases from 3.6 days to 0.5 days. This was matched with an improvement in average LOS from 13.9 days to 7.0 days for these urgent cases with no overall impact on LOS for the other patients.

Conclusion This project demonstrates a successful model for measuring specialty responsiveness as well as some steps that improved responsiveness in our local milieu. We hope that Time to Specialty, the time before an inpatient is taken over by the specialty team, will become a widely-used outcome measure for acute presentations where intensive specialty support is required.

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