26 A service evaluation of the mechanisms that improve compliance with RTT targets in modern cardiology

Introduction Demand for outpatient cardiology appointments is steadily increasing as the population grows and ages. The 18-week referral to treatment (RTT) target proposes a challenge to many NHS Trusts. In our Trust, current compliance with the RTT for general outpatient cardiology clinics is only 57.2% with current waiting time of 7 months. Reducing outpatient waiting times is one of the main targets outlined in our Trust's Strategy plan 2023–2027. Methods We performed a service evaluation of the current mechanisms utilised to improve RTT compliance: enhanced triaging, physiologist-led valve clinic and patient-initiated follow-up (PIFU). Results Enhanced triaging was implemented in our Trust in 2021. The effects of enhanced triaging in improving RTT compliance are twofold: rejecting or re-directing new referrals but also enabling early discharge by booking investigations prior to first appointment. We performed a service evaluation of enhanced triaging. We identified that 41% (n=161) of referrals were rejected over a 3-month period due to variety of reasons (inappropriate, incomplete documentation, advice and guidance given instead) [figure 1a]. In addition, 36% of patients had investigations (echocardiogram and/or Holter) [figure 1b] prior to first appointment which may have contributed to a small increase in discharge rates on first appointment from 21.9% in 2021 to 23.6% in 2023 [figure 1c, 1d]. Our physiologist-led valve clinic provides a way to reduce follow-ups in general clinic by enrolling patients with stable valve disease. We undertook a service evaluation of the valve clinic's activity. Over a 3-month period, 64 patients (53% male, mean age 69), were reviewed in clinic. Figure 2 shows the distribution of valve pathologies in this group. Collectively, 121 appointments were saved from the general cardiology clinic for this group of patients since enrolment. Finally, PIFU gives patients flexibility to book follow-up appointments only when required, rather than routinely, and results in reduction of unnecessary follow-ups. We audited the use of PIFU from our consultant body. We identified a large variation in utilising PIFU between 1 and 70 referrals per consultant (figure 3a). To address this inconsistency, we introduced a document proposing cardiology patients that would be suitable for PIFU and distributed this within our department following a clinical governance meeting (figure 3b). Conclusion Here, we evaluate 3 mechanisms that contribute towards improving compliance with RTT targets. We encourage departments across the United Kingdom to utilise these or other local pathways to tackle long waiting lists in an overwhelmed NHS. Conflict of Interest None