Reducing Trainee Service Provision Burden: An Audit of Cardiac Surgical Follow-Up

To standardize the discharge policy for outpatient appointments and reduce the burden of service provision placed on trainee surgeons.

Retrospective audit of practice followed by a prospective audit following our intervention.

Cardiac surgery outpatient clinic at Liverpool Heart and Chest Hospital, a large tertiary cardiothoracic center in the United Kingdom.

All patients (total 1002) attending postcardiac surgery follow-up appointments in the periods January to March 2015 (n = 428), February to March 2016 (n = 250), and February to March 2017 (n = 324).

Introduction of departmentally agreed guidelines on discharge from follow-up reduced the number of inappropriate recalls among patients attending their first postoperative appointment (4.6% vs 17.6%; p < 0.001), which was maintained at 1 year (4.5% vs 17.6%; p < 0.001). In the initial cohort, a significantly higher proportion of patients were inappropriately recalled if they were seen by registrars who were not from the operating consultant's team (11.7% vs 24.1%; p = 0.007); this was not apparent after the guidelines were introduced (5.4% vs 3.8%; p = 0.62). There was no increase in the number of patients referred back to the cardiac surgical department after introduction of the guidelines (0.71% vs 2.8%; p = 0.078). We calculated an annual cost saving of £3841 ($5377). There was a significant increase in the number of new patients seen by trainees in each clinic (0.15 vs 0.38, p = 0.04).

Implementation of a discharge guideline decreased the number of unnecessary attendances at the outpatient clinic without an increase in subsequent re-referrals and was cost neutral. Trainees were able to assess more new referrals, increasing the educational value of the clinics.