Co-ordinating same day visits across medical specialties

Today’s Patient: A register-based cross-sectional study on organising Same Day visits across specialties in outpatient clinics for multimorbid patients

Objective

This study investigated the utilisation of healthcare of patients managed simultaneously in two or more  specialist outpatient clinics at the University Hospital of Southern Denmark, Hospital Sønderjylland.

Specifically, we aimed to investigate the proportion of same-day visits and days between patients’ last visit and the subsequent visit in a different clinic that could be coordinated to occur on the same-day.

Method

This study was a register-based cross-sectional study. We collected data on adult patients managed in nephrology, pulmonology, endocrinology, cardiovascular and wound outpatient clinics in the period from 01 October, 2021 to 28 February, 2022. Descriptive statistics were used to present the patient groups and examine health care utilisation.

Results

4,768 patients completed a total of 7,569 visits.
325 patients were managed (6.8%) in two or more clinics accounted for 973 visits.
Of the 973 visits (100%), 9.4% were coordinated as same-day visits, while 21.5% were close proximity visits, i.e. 1-30 days between their last visit in one outpatient clinic and their subsequent visit in another (see table 1).
Patients managed in two clinics were frequently managed simultaneously in a cardiology and a pulmonary clinic (36.5%) followed by endocrinology and nephrology (18.9%).

Conclusion
The findings showed that while only about 1 out of 10 visits for patients managed in one or more clinics were currently coordinated on the same-day, a further 21.5% visits could be coordinated to occur as same-day visits. Scheduling multiple appointments on the same-day has the potential to improve the trajectories for both patients and healthcare professionals.

Implications for Quality Improvement Initiatives at University Hospital of Southern Denmark
Based on the study findings the University Hospital of Southern Denmark are considering the following quality improvement initiatives:

Evaluation of Follow-up Practices: To enhance patient care and optimise resource utilisation, the outpatient clinics are currently evaluating their patient follow-up practices and guidelines. This aims to provide tailored care for patients who require frequent hospital outpatient visits and monitoring due to the severity of their illness. Simultaneously, it considers alternative forms of follow-up appointments for patients with stable clinical outcomes who requires less intensive medical attention. 

Identifying multimorbid patients: Identifying patients connected to two or more outpatient clinic at referral point.

Joint Consultations: For patients connected to multiple outpatient clinics, joint consultations are being considered to improve coordination and ensure comprehensive care.