This project began as an audit of performance against the 18-week referral to treatment time (RTT) target but became an interesting development in clinical training. The electronic documents and PACS images for 50 consecutive routine GP referrals to an orthopaedic clinic were traced using the UCPN (Unique Care Pathway Number). The average time from referral to 1st clinic appointment was 57 days (range 29–117). 16 were discharged at 1st visit. 26 were listed for surgery: 20 at the 1st clinic, 3 at the 2nd clinic, 2 at the 3rd clinic, 1 after test results without clinic review. Average time from referral to listing was 68 days (range 28–177). For 25 patients who had surgery, average RTT was 164 days (61–394). 14 patients breached the target. The UCPN allows an overview of the diagnostic work-up for the whole care pathway. Time constraints and less opportunity for continuity of care have hampered effective training in the outpatient clinic. Using the UCPN in this way allows detailed case-based discussions to develop the non-technical surgical skills (NOTSS) of situation awareness and decision-making. In a system where 57 days are typically wasted waiting for a new clinic appointment, clinical reasoning skills must be scalpel sharp to meet the 18-week RTT target. This study hints that better characterising the third of patients discharged and the third directly listed for surgery at the first visit might help with demand management. Better characterising the third of patients needing further tests might allow those test results to be available by the first visit. The next step is to test if, indeed, the UCPN is an effective tool to hone mental dissection.
