A Direct Booking Hernia Service – A shorter wait and a satisfied patient

Introduction

Patients requiring routine operations often have lengthy waits for outpatient appointments and surgery. Our aim was to reduce this wait by offering patients a Direct Booking Hernia Service and to assess its efficacy and its acceptability to patients.

Methods

Two groups of patients referred for treatment of an inguinal hernia were compared. Group 1 were those referred to a single named consultant and all those referred without specifying a consultant's name during the same period. Group 2 were those referred to any other named consultant at the same hospital during the same period. For those in Group 1, the referral letter was triaged by a single surgeon and sent directly to the Day Surgery Unit (DSU). The patient's first appointment was for nurse led pre-assessment in the DSU. At the same visit the duty DSU surgeon checked the hernia to confirm the diagnosis. If medically fit, patients were offered a date for operation within 4 weeks of their pre-assessment. If unfit for DSU, the nurses would discuss the patient with the DSU lead anaesthetist and could book them directly onto an inpatient list or refer them to the outpatient clinic. Group 2 patients followed the traditional pathway of outpatient clinic, then booking for surgery. Group 1 patients were invited to complete a patient satisfaction questionnaire following their treatment.

Results

There were 74 patients in Group 1 and 147 in Group 2 during the study period. In Group 1 3/74 (4.1%) did not have hernias at pre-assessment. The mean total waiting time from referral to surgery was 70 days. In Group 2 the mean wait for an out-patient appointment was 77 days, and the wait from outpatient appointment to surgery was 84 days, giving a total average waiting time of 161 days. The proportion of patients treated as day cases was 88.7% in Group 1 and 70% in Group 2. 43% of Group 1 patients responded to the questionnaire. 94% of these would recommend the service to a friend.

Conclusion

The Direct Booking Hernia Service provides an efficient way of treating patients requiring inguinal hernia repair that is acceptable to patients. It significantly reduces waiting times and reduces the load on outpatient appointments.