The "jaundice hotline" for the rapid assessment of patients with jaundice: quality improvement report. (Education and debate).

Abstract

Problem Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay.

Design An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources.

Background and setting A large general hospital in a largely rural and geographically isolated area.

Key measures for improvement Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service.

Strategies for change Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available.

Effects of change Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent.

Lessons learnt An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost.

Background and setting

The acutely jaundiced patient requires rapid assessment, diagnosis, and treatment. Initial assessment should include history, examination, laboratory investigations, and abdominal ultrasonography. (1) One possible diagnosis is hepatobiliary malignancy, so rapid diagnosis and treatment are important to avoid evoking considerable anxiety in the patient. This is particularly relevant in the United Kingdom, because a recent government initiative has dictated that patients with a suspected diagnosis of malignant disease must be seen by a specialist within two weeks. (2) Jaundice fulfils the criteria for referral under this scheme. This ruling has put considerable strain on existing health …