A dietitian-led gastroenterology clinic model of care can reduce wait times and relieve the burden on outpatient gastroenterology services, a Queensland pilot program has shown.
When introduced at the Gold Coast Hospital in 2016, a dietitian-led clinic for low-risk gastroenterology patients cut wait times from 280 to 66 days and also cleared the waiting list of people who had already exceeded the recommended wait time.
The service was set up to deal with low risk patients who were triaged by a gastroenterologist from GP referrals. The criteria included younger (<50 years) patients with GI symptoms., and excluded patients with ‘red flags’ such as weight loss, iron deficiency, abnormal imaging and persistent symptoms.
In an initial audit about 10% of patients on the gastroenterology clinic wait list were deemed eligible for dietitian-led clinic, and 658 were triaged by the gastroenterology consultant.
The most common referral reasons were abdominal pain (47%) dyspepsia/heartburn/reflux (22%) and diarrhoea (21%).
Under an extended scope of practice model, dietitians were trained to screen for organic disease, and request a range of blood and stool tests including liver function tests, coeliac serology, H. pylori and C-reactive protein. Dietitians provided diet and lifestyle advice and could be referred on to a specialist gastroenterologist or discharged to their GP
Almost 70% of patients triaged to the dietitian-led clinic were discharged without requiring specialist gastroenterologist input, while 10% were triaged back to the consultant after additional ‘red flags’ were identified.
With the dietitian-led clinic the average treatment time was 53 days, the average number of services was 2.4 and the number of gastroenterology patients in breach of recommended wait times was reduced from 95% to zero.
Writing in Frontline Gastroenterology, the study authors said the service got high levels of positive feedback from patients, who expressed satisfaction with the service, confidence in the clinicians and approval of the reduced wait times.
They said the pilot program showed that a significant proportion of referrals to gastroenterology outpatients could managed by dietitian-led clinics, “increasing the capacity for medical specialists to see more urgent and complex cases.”
“The reallocation of eligible patients directly from the general gastroenterology wait list to the [dietitian-first gastroenterology clinic] wait list can result in reduced wait times for these patients, allowing assessment within clinically recommended time frames even within the context of increasing overall service demand.
“This is of clinical significance as long wait times contribute to the delay between diagnosis and treatment, which may impact on treatment outcomes for patients with serious pathology.”
Dietitian-led clinics could also reduce patient anxiety and frustration due to long waits and help avoid unnecessary investigations, they added.