A STUDY OF ELECTIVE ORTHOPAEDIC CONSULTATION TIME IN A DISTRICT GENERAL HOSPITAL.

Abstract

Background: The British Orthopaedic Association (BOA) guidelines regarding consultation time were published in 1990. There has been a change in the expectation of the patient and the responsibilty of the clinician to provide more information to the patients and more detailed investigation and consent forms to fill with a greater emphasis on clinical governance and increasing awareness of the patients over the years. The decrease in doctor working hours and increase in sub specialisation can not be ignored.

Methods: 55 Orthopaedic clinics were observed and time mapped to the nearest second. 5 clinics observed for each of 11 clinicians (5 Consultants and 6 Registrars). From the time the clinician entered the consultation room to start the clinic till the time he left after finishing the clinic the entire span of time was mapped with a stop watch by an independent observer. The patient factors viz age, sex, mobility, BMI, site of disease were recorded. The clinician factors viz. seniority, sub-specialisation were also recorded.

Results: Of total Clinic time, 45% spent for consulting follow up cases, 26% for new cases and 29% lost in in-between patient transit time. Of the total clinic time, patient time (time spent by clinician with the patient) was 75%, 4% spent on procedures, 3% on investigations, 4% on consent, 13% on dictation, only 1% on teaching. The mean time for consultation was 13 minutes 6 seconds for New patients and 8 minutes 43 seconds for Follow up patients which was significantly less than that recommended by BOA guidelines (15 – 20 minutes for new and 10 –15 minutes for follow up pateints in Orthopaedic clinics).

Conclusion: Despite the clinics over running in time the BOA guidelines are not being adhered to potentially compromising quality consultation and training at the cost of pressures to see the recommended 22 unit patients per clinic. There is a need to revise guidelines to provide for more time in clinics per patient to maintain quality of care and training.