EFFICIENCY IN THE OUTPATIENT DEPARTMENT - THE LESSONS FROM UROLOGY

To determine the scope for improvements in efficiency in the outpatien t management of urological patients, a retrospective analysis was unde rtaken of outpatient records from one consultant's practice in a regio nal teaching hospital. Two hundred consecutive patients referred betwe en March and May 1992 were studied for 1 year after referral. Each out patient visit was judged to be unavoidable or potentially avoidable. O f referrals, 72% were in one of four diagnostic categories (bladder ou tflow obstruction; haematuria; scrotal disorders; frequency/dysuria sy ndromes). Of these patients, 90% were seen only once or twice for each episode of illness. Of the visits, 150/347 (42%) were potentially avo idable. Patients with suspected bladder outflow obstruction, haematuri a and scrotal disorders should undergo imaging of the relevant anatomy before referral. Patients with haematuria should be referred directly for a flexible cystoscopy after imaging. Urologists need to educate g eneral practitioners more clearly about the indications for the treatm ent of scrotal swellings in elderly men and mild bladder outflow obstr uction in middle-aged men. Patients need not be reviewed routinely aft er transurethral resection of the prostate for benign prostatic hypert rophy or after investigations for haematuria have revealed no serious abnormality.