title: Assessing the feasibility of a one-stop approach to diagnosis for urological patients.
abstract: BACKGROUND
  Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes.
  
  
  METHODS
  A total of 330 consecutive patients referred to the urology department of Guy's and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient.
  
  
  RESULTS
  Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved.
  
  
  CONCLUSIONS
  A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow-up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.
authors.affiliation: Department of Urology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK. nquatan@hotmail.com
authors.forename: Nadine
authors.initials: N
authors.lastname: Coull
authors.forename: Giles
authors.initials: G
authors.lastname: Rottenberg
authors.forename: Sheila
authors.initials: S
authors.lastname: Rankin
authors.forename: Maria
authors.initials: M
authors.lastname: Pardos-Martinez
authors.forename: Bola
authors.initials: B
authors.lastname: Coker
authors.forename: Elaine
authors.initials: E
authors.lastname: Jenkins
authors.forename: Tim
authors.initials: T
authors.lastname: O'Brien