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Health technology assessment
Original research
The Mass Knee Clinic: a new NHS outpatient care model showing clinically led transformation in practice
  1. Lily Li1,
  2. Sam Nahas1,
  3. Rajan Jandoo1,
  4. Sarah Williams2,
  5. Haddon Paul Lionel Ganippa3,
  6. Rajarshi Bhattacharya1,
  7. Dinesh Nathwani1
  1. 1 Imperial College Healthcare NHS Trust, London, UK
  2. 2 Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  3. 3 Imperial College London, London, UK
  1. Correspondence to Miss Lily Li, Imperial College Healthcare NHS Trust, London, UK; lily.li{at}nhs.net

Abstract

Background The Mass Knee Clinic is an innovative, patient-focused and efficient clinic introduced into our hospital in April 2017. The UK Government has mandated referral-to-treatment (RTT) time for patients to be within 18 weeks to improve patient care. The new clinic involves seeing high numbers of patients by amalgamating all new non-traumatic knee disorders (up to 200) from primary care into one clinic day every 6 weeks. The premise and success of the clinic is multifactorial and involves focused multidisciplinary consultant-led care in every case, training opportunities for junior doctors, a ‘one-stop shop’ for patients allowing them to be seen by a consultant, physiotherapist and receive a date for surgery all in 1 day, and subspeciality consultant presence, preventing multiple reattendances.

Methods We present the results of prospectively collected data on wait times to clinic, time-to-treatment and outsourcing of new referrals, 1 year after the initiation of the new clinic model (n=56). This data was compared with data 1 year prior to the Mass Clinic being introduced (n=56).

Results Time from primary care referral to first Orthopaedic review was reduced from median 13.5 weeks to 11 weeks (statistically significant (p=0.00512)). RTT was reduced from median 30.5 weeks to 15.5 weeks (p<0.01), allowing a significant reduction in waiting times for the patient. Outsourcing was eliminated, and the number of appointments per patient also halved.

Conclusions The new Mass Clinic with focused consultant-led care and multidisciplinary approach has led to significant reductions in patient wait times and cost savings for the hospital.

  • economics
  • musculoskeletal
  • orthopaedics

https://doi.org/10.1136/bmjinnov-2019-000419

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    Footnotes

    • Contributors LL collected data, analysed data and wrote the paper. SN collected data, analysed data and cowrote early drafts of the paper. RJ and HPLG collected data and analysed data. SW collected data. RB planned the study, reviewed the data and reviewed the final drafts. DN planned the study, reviewed the data, reviewed the final drafts and is the guarantor of the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement statement We did not directly include formal patient and public involvement (PPI) in the design of this study due to lack of funding and time; however, there was PPI during the implementation of the study and we responded to feedback.

    • Patient consent for publication Not required.

    • Ethics approval This project was approved by the hospital's Safety & Effectiveness Team, and presented at the local clinical governance meeting. This article does not contain any studies with human participants or animals performed by any of the authors.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.