{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T14:53:15Z","timestamp":1758120795467,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2017,8,19]]},"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>An electronic \u2018Clinical Assessment Service\u2019 (CAS) proforma and an information platform were developed, and all data were analysed retrospectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Royal Wolverhampton NHS Trust.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>14 245 general practitioner (GP) referrals were received during January 2014\u2013December 2016 with 9773 of them being triaged via our CAS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>We looked into patients\u2019 clinical outcome along with departmental performance and finances.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of \u00a3481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2017-100853","type":"journal-article","created":{"date-parts":[[2017,9,23]],"date-time":"2017-09-23T20:10:13Z","timestamp":1506197413000},"page":"159-165","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Impact and cost-effectiveness of formal gastroenterology outpatient referral Clinical Assessment Service"],"prefix":"10.1136","volume":"9","author":[{"given":"Stavroula","family":"Pelitari","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Hathaway","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Gritton","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Smith","sequence":"additional","affiliation":[{"name":"Wolverhampton CCG, Wolverhampton Clinical Commissioning Group, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bush","sequence":"additional","affiliation":[{"name":"Wolverhampton CCG, Wolverhampton Clinical Commissioning Group, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McKaig","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,9,23]]},"reference":[{"key":"2025090709154559000_9.2.159.1","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1111\/codi.13038","article-title":"Impact of the United Kingdom national bowel cancer awareness campaigns 2012 on colorectal cancer services and patient survival","volume":"17","author":"Khong","year":"2015","journal-title":"Colorectal Dis"},{"key":"2025090709154559000_9.2.159.2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.722"},{"key":"2025090709154559000_9.2.159.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hsdr04150","article-title":"Outpatient services and primary care: scoping review, substudies and international comparisons","volume":"4","author":"Winpenny","year":"2016","journal-title":"Health Services and Delivery Research"},{"key":"2025090709154559000_9.2.159.4","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.ijmedinf.2013.08.003","article-title":"Improving referral activity on primary-secondary care interface using an electronic decision support system","volume":"82","author":"Mariotti","year":"2013","journal-title":"Int J Med Inform"},{"key":"2025090709154559000_9.2.159.5","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/jep.12429","article-title":"Optimizing the pre-referral workup for gastroenterology and hepatology specialty care: consensus using the Delphi method","volume":"22","author":"Ho","year":"2016","journal-title":"J Eval Clin Pract"},{"key":"2025090709154559000_9.2.159.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i6856"},{"key":"2025090709154559000_9.2.159.7","unstructured":"Department of Health. Responsibilities and operational requirements for the correct use of choose and book, 2009. www.mysurgerywebsite.co.uk\/website\/IGP367\/files\/CB_-_responsibilities_and_requirements.pdf (accessed 9 Feb 2017)."}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2017-100853","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T16:15:55Z","timestamp":1757261755000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2017-100853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,23]]},"references-count":7,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,3,8]]},"published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1136\/flgastro-2017-100853"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2017-100853","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"type":"print","value":"2041-4137"},{"type":"electronic","value":"2041-4145"}],"subject":[],"published":{"date-parts":[[2017,9,23]]}}}