Cost-analysis and patient experience of a one-stop bariatric

clinic David Bunting

Ian Finlay

Background

• Royal Cornwall Hospital

• Single bariatric centre in Cornwall

• Resident population 535,300*

• Sparsely populated

*Office of National Statistics mid year estimate 2010

Office of National Statistics

Background – NICE Guidance

NICE Guidance

• ‘all appropriate non-surgical measures have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least 6 months’

• Consultations prior to considering surgery– Endocrinologist– Dietician– Exercise therapist

Background

• Care should be within a multidisciplinary team

• One-stop clinic developed

• Consultations required before decision on surgery– Dietician– Anaesthetist – Surgeon

Background

• Free on-site parking

• Three separate consulting rooms

• Afternoon appointments

• Prior to decision regarding suitability for surgery

Study aims

• Patient views/satisfaction

• Strengths and weaknesses

• Identify savings compared to three-stop clinic – travelling time – travelling distance– cost of travel

Methods

• 1 year period

• Patient survey– 10-point visual analogue scale– tick-boxes – free-text boxes

• Travelling distances and times recorded

• Travel cost estimated

• Savings calculated

Results

• 29/46 patients responded (63%)

Duration of appointment

Usefulness of appointment

Efficiency of clinic

Ease of getting to clinic

Journey distance one-way

Journey times – one way

Results

• Distance travelled– Average 23.3 miles one-way

• Travel time– Average 1hr 36 minutes one-way

• Travel cost– Average £9.31

Results

• Travel distance saved– 93 miles per patient (up to 228 miles)

• Travel time saved– 3 hours 13 minutes per patient (up to 10

hours)

• Travel cost saving– £37.20 (up to £91.20)

Waited longer than expected

Waited longer than necessary

Prefer one-stop clinic

Patient comments

• Not enough information on post-operative diet

• Decision regarding suitability for surgery not made on the day

• Long distance to clinic

• Travelling time

Patient comments

• On-site free parking

• Friendliness of staff

• Not made to feel guilty

• Not rushed

• Put at ease

• Good information/advice given

Limitations

• Response rate– sampling bias

• Survey delivered by hospital– positive satisfaction bias

Conclusions

• One-stop clinic– Feasible– Acceptable to patients– Considerable reductions in travelling distance

and times

• Inform patients prior to clinic– Process can take up to 3 hours– Decision regarding surgery not made instantly

Acknowledgements

• Bariatric team– Surgeons– Dieticians– Anaesthetists– Bariatric secretary– Bariatric nurse specialist

• Patients