Outpatient Redesign Programme - rcsi.ie for Outpatient... · Phimosis/redundant prepuce Y81 68 2.2%...
Transcript of Outpatient Redesign Programme - rcsi.ie for Outpatient... · Phimosis/redundant prepuce Y81 68 2.2%...
The VisionPerson-centred outpatient services delivering high quality care for all
The MissionTo ensure people can access a high quality, integrated, holistic outpatient services when they need it
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18-21Months
21-24Months
24-36Months
36-48Months
48+Months
Number
Patients awaiting outpatient consultation Jan 31st 2017 and 2018 in time bands
2018-01-31
2017-01-31
Otolaryngology (ENT)OrthopaedicsOphthalmologyUrologyDermatology
Core Principles• Patient-centred
• Standardised, clinically-designed, nationally-agreed pathways
• Electronic / paper-free
• Transparent – fit for purpose data systems
• New ways of working– Telemedicine/virtual healthcare– Advice only options– Multidisciplinary services– Direct access– Ambulatory care– Commissioning model– Activity based funding
Prioritising Patients & Referral Pathways
• Clinical prioritisation needs to be based on a set of agreed ‘definitions’ or ‘criteria’, with attached ‘clinically-recommended timeframes’.
• National working group comprised of range of surgical and medical specialty leads, clinical advisor, OSPIP, public health
Prioritisation Outcome
Clinical characteristics/outcomes of conditions within category
Recommended time to consultation to
minimise risk and/or achieve best clinical
outcomes Notes/discussion points
Immediate
• Imminent risk of death• Trauma major or minor• Irreversible deterioration if not seen
immediately
Same day
Patients should be sent to ED/minor injury unit /AMAU as appropriate, or a same day rapid access clinic where that facility exists
Urgent
• Risk of permanent damage to organ system if treatment is delayed beyond CRT
• Major functional impairment • Suspected malignant neoplastic
disease• Rapidly progressing dysfunction (over
a period of days or weeks) in established conditions
≤ 28 days
NCCP/Individual specialties and/or subspecialties may set urgent CRT at less than 28 days (e.g., as per breast disease)
Semi-Urgent
• Risk of damage to organ system if treatment is delayed beyond CRT
• Moderate functional impairment or progressive loss of function over a period of months or years
• Benign neoplastic disease• Significant restriction of economic
activity
≤ 13 weeks
Individual specialties and/or subspecialties and/or conditions may set semi-urgent CRT at less than 13 weeks for internal clinical management
Non-urgent
• Minimal risk of damage to organ system if treatment is delayed beyond 13 weeks
• Moderate functional impairment• Significant restriction of social activity• Management issues in established
conditions• Reassessment of stable/chronic
conditions that meet the criteria for review
≤ 26 weeks
Excluded
• Conditions that have no impact on physical well-being, e.g., work assessments, cosmetic surgery
• Sub-acute or minor conditions/complaints that will be safely diagnosed and/or managed in primary care.
Specialties can decide on specific conditions/complaints, based on literature and/or international best practice, taking account of Irish health system’s structure.
[1] Significant restriction resulting in inability to work/support self and/or dependants [2] Resulting in a deterioration of the person’s overall well-being and/or mental health
Progress to Date• Cardiology • Dermatology • Endocrinology • ENT• Gastroenterology• General Medicine• General Surgery• Gynaecology• Haematology• Immunology• Neurology• Ophthalmology• Orthopaedics• Paediatrics• Respiratory• Rheumatology• Urology
Symptoms/System
Clinical priority and recommended time-frame
Genitourinary traumaAll trauma Immediate (Same day)Urinary tract symptoms/presentationAcute ureteric colic Immediate (Same day)Septicaemia of suspected urinary origin Immediate (Same day)Acute and chronic urinary retention Immediate (Same day)Hydronephrosis Urgent (< 28 days)Visible, painless haematuria in adults or children Urgent (< 28 days)Microscopic haematuria in adults over 50 years Urgent (< 28 days)Microscopic haematuria in patients aged less than 50 Semi-Urgent (< 13 weeks)
Females aged 40 years and older who present with recurrent or persistent urinary tract
infection associated with haematuria Semi-Urgent (< 13 weeks)
Any UTI in a male Semi-Urgent (< 13 weeks)Females with recurrent, 3 or more per year, or persistent UTI Semi-Urgent (< 13 weeks)
Lower urinary tract symptoms classified severe as per International Prostate Symptom Score,
with or without renal impairment, yet no evidence of urinary retentionUrgent (< 28 days)
Lower urinary tract symptoms, classified as moderate as per International Prostate Symptom
Score, with no renal impairment
Non-Urgent (<26 weeks)
Lower urinary tract symptoms, classified as mild as per International Prostate Symptom Score,
with no renal impairmentManage in primary care
Female and male incontinence where conservative management fails Non-Urgent (<26 weeks)
Suspicious abdominal masses originating from the urinary tract found on examination and/or
imagingUrgent (< 28 days)
Abdominal pain suggestive of urinary tract origin but not typical acute ureteric colic Urgent (< 28 days)Renal calculi Semi-Urgent (< 13 weeks)Suspected neurogenic bladder Semi-Urgent (< 13 weeks)Scrotal SymptomsAcute scrotal pain Immediate (Same day)
Chronic scrotal pain (>3 months) Semi-Urgent (< 13 weeks)
Scrotal swellings suspicious for testicular cancer Urgent (< 28 days)Suspected hydrocele on clinical examination, or proven on ultrasound Non-Urgent (<26 weeks)Suspected epididymal cyst on clinical examination, or proven on ultrasound Non-Urgent (<26 weeks)Adolescent varicocoele Semi-Urgent (< 13 weeks)
An undescended testis (one that cannot be manipulated into the bottom of the scrotum) in
child >3 monthsSemi-Urgent (< 13 weeks)
ProstateElevated age-specific prostate specific antigen (PSA) in men under 70 in accordance with
current NCCP guidelines
Urgent (< 28 days)
Elevated age-specific prostate specific antigen (PSA) in men over 70 in accordance with current
NCCP guidelines
Urgent (< 28 days)
Hard, irregular prostate suspicious of prostate carcinoma (see NCCP guidelines) Semi-Urgent (< 13 weeks)See urinary tract symptoms for additional prostate-related conditions
Haematospermia Urgent (< 28 days)
PenisPriapism Immediate (Same day)
Suspected Peyronie’s disease Semi-Urgent (< 13 weeks)
Penile lesion suspicious for penile cancer Urgent (< 28 days)Chronic penile pain Semi-Urgent (< 13 weeks)
Erectile Dysfunction Non-Urgent (<26 weeks)
Non-retractile foreskin Non-Urgent (<26 weeks)
General Male fertility and Reproductive/sexual healthLoss of libido in males Non-Urgent (<26 weeks)
Male infertility Non-Urgent (<26 weeks)
Vasectomy / Reversal of vasectomy Non-Urgent (<26 weeks)
Pelvic SymptomsChronic pelvic pain Semi-Urgent (< 13 weeks)
Symptom-based
• ICPC-2Presenting complaint ICPC-2 code Grand Total % of totalProstate cancer assessment U26 461 14.8%
Urinary frequency/urgency U02 384 12.3%
Haematuria U06 345 11.1%
Cystitis/urinary infection other U71 325 10.4%
Scrotum/testis symptom/complaint other Y05 246 7.9%
Urinary calculus U95 188 6.0%
Penis symptom/complaint other Y04 166 5.3%
Urine symptom/complaint other U07 108 3.5%
Kidney symptom/complaint U14 102 3.3%
Pain in testis/scrotum Y02 97 3.1%
Urinary retention U08 88 2.8%
Balanitis Y75 79 2.5%
Incontinence urine U04 69 2.2%
Hydrocoele Y86 69 2.2%
Phimosis/redundant prepuce Y81 68 2.2%
Orchitis/epididymitis Y74 55 1.8%
Malignant neoplasm of kidney U75 45 1.4%
Dysuria/painful urination U01 41 1.3%
Sexual function symptom/complaint male Y08 36 1.2%
Pain in penis Y01 36 1.2%
Urethral discharge male Y03 25 0.8%
Malignant neoplasm urinary tract other U77 12 0.4%
Undescended testicle Y83 11 0.4%
Malignant neoplasm of bladder U76 9 0.3%
Infertility/subfertility male Y1Q 8 0.3%
Urinary symptom/complaint other U29 8 0.3%
Bladder symptom/complaint other U13 7 0.2%
Urination problems other U05 7 0.2%
Sterilization male Y13 6 0.2%
Injury urinary tract U80 3 0.1%
Benign neoplasm urinary tract U78 2 0.1%
Glomerulonephritis/nephrosis U88 2 0.1%
Malignant neoplasm male genital other Y78 2 0.1%
Prostate symptom/complaint Y06 1 0.0%
Fear of genital cancer male Y26 1 0.0%
Urinary disease other U99 1 0.0%
Benign/unspecified neoplasm male genital Y79 1 0.0%
Grand Total 3,114 100.0%
• ‘referral info’ set out per condition
• Consultant response items set out– Advice– Diagnostics– Virtual consultation– Request more information