The Introduction of an Adult Sweat Test Clinic in an Acute Dublin Academic Teaching Hospital

Aim: The aim of this organisational development project was to introduce a sweat test clinic for adult patients’ in a large academic teaching hospital.

Rationale: The sweat test is used in the diagnosis of cystic fibrosis. The introduction of Ivacaftor, trade name Kalydeco®, for a particular subset of cystic fibrosis patients and the recognition of milder phenotypes of cystic fibrosis in adults had resulted in an increased demand for an adult clinic. Prior to the introduction of the adult service 33 adults were awaiting sweat test appointments and unable to access a sweat test service.

Change process: The Health Service Executive change model was used as a framework to guide the change process. A vision for the change was created and the introduction of the clinic was aligned to the mission of the organisation and that of the Health Service Executive, that patients’ will have access to high quality health care.

Evaluation: The context, input, process and products model was used to evaluate the organizational development process. This involved evaluation each of the objectives of the project. A target of 8 weeks wait time for an appointment has been achieved.

Results and conclusions: The adult sweat test service was implemented with two out of 14 patients’ having a chloride result indicative of cystic fibrosis. A further 19 patients are scheduled for appointment. Use of a structured change model guided successful implementation of the clinic. The target appointment wait time will require regular auditing by the Clinical Chemistry Department to ensure compliance. This will form part of the regular auditing of services as part of the overall laboratory quality management system. The service will be monitored for any increase or decrease in demand ensuring effective use of resources. This is report monthly at the Clinical Chemistry Operational Group meeting.