Abstract
BACKGROUND: A nurse practitioner-led dysphagia service was introduced to improve appropriateness of investigations. OBJECTIVE: To determine the clinical outcomes and efficacy of this service. DESIGN AND PATIENTS: A 7-year prospective audit of the first 2000 patients referred for investigation of dysphagia. SETTING: Royal Cornwall Hospitals NHS Trust. INTERVENTION: An innovative nurse practitioner-led telephone dysphagia hotline (DHL) assessment service for all patients and consultant review following investigation prior to discharge. OUTCOMES: Clinical outcomes, service efficiency and cost effectiveness. RESULTS: 2000 patients (median age 70 years, 48% male) were referred in less than 7 years, 1775 being managed fully through the DHL. 67% patients had gastroscopy only, 13% barium swallow only and 8.8% both and 11.2% had no investigation. Reflux was the commonest cause (41.3%), 9% had peptic stricture, 10% malignancy 1.9% pharyngeal pouches and 0.8% achalasia. The did not attend rate was reduced from 3.9% to 1.1% and 151 patients either refused or did not require investigation saving a potential £53 040. Although some patients with pharyngeal pouches had gastroscopy as initial investigation, no complications resulted. CONCLUSIONS: The nurse practitioner-led DHL service has improved efficiency and resulted in a safe prompt service to patients.