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