636 Evaluating the utility and effectiveness of a registrar-led rapid access clinic

Background Learning to manage patients in an outpatient setting is an essential skill for Paediatricians in training. It is also a key learning outcome for Level 3 Paediatric trainees as outlined in the RCPCH curriculum. A registrar-led Rapid Access Clinic (RAC) was introduced in a busy district general hospital (DGH) in October 2020, following feedback from trainees about a lack of exposure to outpatient care. The clinic was commenced to fulfil the training gap for trainees and also to alleviate the pressure on A&E and consultant clinics. A standard operating procedure detailing patient eligibility criteria and the referral process was created and approved by the consultant body. Letters were sent out to the Clinical Commissioning Groups to raise awareness with the local General Practitioners in September 2020. The RAC aimed to see patients within two weeks of referral. We undertook a quality improvement project to evaluate use of the clinic and the experiences of trainees. Objectives Our objectives were to audit the number of referrals to the RAC, the use of available slots and the number of patients seen within two weeks of referral. We also aimed to gain feedback from trainees on their experiences in clinic and whether they felt sufficiently supported. Methods Data was collected over a 12-week period from 13/10/20–29/12/20. We retrospectively reviewed referral and clinic letters through the hospital’s electronic notes system. Data collected included: number of slots used, reasons for unutilised slots, age, presenting complaints, source of referrals, number of days from referral to appointment and clinic outcomes. We also surveyed the registrars for feedback on how the clinics have impacted their training. Results We found the overall utilisation of the clinic to be 62% (57/92 slots were used). On further examination of the reasons for low utilisation, we found that three clinic days were not used, possibly due to staffing issues and six slots were unfilled due to patient non-attendances. 17 slots were unaccounted for, likely due to a lack of referrals. 77% of patients were seen within the goal of two weeks from referral. Approximately 50% of patients were discharged from clinic, and the other half were referred onwards to another speciality, General Paediatrics or an allied health professional for follow up. The feedback obtained from registrars highlighted other areas for further improvement. Most registrars found the clinic helpful with good levels of consultant supervision. Feedback was categorised into four areas: more time for administrative tasks, improvement in the clinic set-up, implementation of training on how to conduct a clinic, and formalising consultant feedback on management plans made. Conclusions In conclusion, the RAC was shown to fulfil an important training need for Paediatric trainees in a DGH setting. The majority of patients were seen within the target time but slots could be better utilised by improving staffing levels and raising awareness within primary care. Feedback from the registrar survey has helped in planning effective interventions. Following the implementation of these changes, we will re-audit to assess improvements in the utilisation and registrar experience of the clinic.