Reducing Unnecessary Endocrine Out-Patient Appointments Following Dynamic Function Tests

Numbers attending outpatient services are rising and are forecast to continue rising in Ireland up to 2031. The chronicity of many endocrine diseases contributes to high volumes in endocrine outpatients. Some of these are appointments to review results of Dynamic Function Tests (DFT), a number of which have been identified as unnecessary, in a University Teaching Hospital in Ireland. This Quality Improvement Project Plan(QIPP) aims to reduce the number of unnecessary endocrine outpatient appointments following DFTs. Using Lean Six Sigma’s Define, Measure, Analyse, Improve, Control framework, unnecessary appointments were measured and possible causes explored using root-cause analysis. Not previewing DFT results was identified as a cause of unnecessary follow-up appointments and was the focus of the improvement plan. Data were collected from thirty-two outpatient appointments. The number of unnecessary appointments was measured and analysed taking into account whether or not DFT results had been previewed. In all cases where DFT results were previewed an unnecessary follow-up appointment was averted. Eliminating unnecessary appointments in this way led to a 37.5% reduction in follow-up appointments, thus freeing these slots for other patients on the wait list. This QIPP proposes establishing a weekly Consultant Triage when consultants preview DFT results in order to determine the next course of action, including whether or not an outpatient appointment is necessary. This is in line with evidence that strategies such as pre-screening can reduce outpatient numbers. The aim of the QIPP is to reduce unnecessary appointments following Dynamic Function Tests by 90-100% over a 9-12 month period.