Efficiency in the outpatient department: the lessons from urology

To determine the scope for improvements in efficiency in the outpatient management of urological patients, a retrospective analysis was undertaken of outpatient records from one consultant's practice in a regional teaching hospital. Two hundred consecutive patients referred between March and May 1992 were studied for 1 year after referral. Each outpatient visit was judged to be unavoidable or potentially avoidable. Of referrals, 72% were in one of four diagnostic categories (bladder outflow obstruction; haematuria; scrotal disorders; frequency/dysuria syndromes). Of these patients, 90% were seen only once or twice for each episode of illness. Of the visits, 150/347 (42%) were potentially avoidable. Patients with suspected bladder outflow obstruction, haematuria and scrotal disorders should undergo imaging of the relevant anatomy before referral. Patients with haematuria should be referred directly for a flexible cystoscopy after imaging. Urologists need to educate general practitioners more clearly about the indications for the treatment of scrotal swellings in elderly men and mild bladder outflow obstruction in middle-aged men. Patients need not be reviewed routinely after transurethral resection of the prostate for benign prostatic hypertrophy or after investigations for haematuria have revealed no serious abnormality.