title: Nurse-led clinic: effective and efficient delivery of assessment and review of patients with hepatitis B and C.
abstract: BACKGROUND
  Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for healthcare. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the healthcare system.
  
  
  OBJECTIVE
  The aim of this study is to assess quantitatively the first 2 years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic.
  
  
  METHODS
  Data were extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly 1-month periods were recorded over 2 years. Patients were categorised according to the path through which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of 'did-not-attend' occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times.
  
  
  RESULTS
  There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified, including effective triage of patients and organisation of appropriate investigations from the initial nurse assessment.
authors.affiliation: School of Medicine, Deakin University, Geelong, Victoria, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Biddle
authors.forename: N R
authors.initials: NR
authors.lastname: Adler
authors.forename: M
authors.initials: M
authors.lastname: Heath
authors.forename: S
authors.initials: S
authors.lastname: Streat
authors.forename: M
authors.initials: M
authors.lastname: Wardrop
authors.forename: J P
authors.initials: JP
authors.lastname: Watson
mesh_terms: D001071:Appointments and Schedules; D005762:Gastroenterology / Q000458:organization & administration*; D006509:Hepatitis B / Q000453:epidemiology / Q000628:therapy*; D006526:Hepatitis C / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D009720:Nurse Clinicians / Q000706:statistics & numerical data*; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009730:Nursing Assessment / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010820:Physicians; D057184:Practice Patterns, Nurses' / Q000458:organization & administration* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage; D014739:Victoria / Q000453:epidemiology
keywords: assessment; hepatitis C virus; hepatology service; nurse-led clinic