P167 Enhanced clinical validation: cost and time savings for routine dermatology waiting lists

Abstract The COVID-19 pandemic had a detrimental effect on dermatology outpatient waiting times across the UK, with Northern Ireland having the worst waiting-list figures. In December 2019, 219 489 patients in Northern Ireland awaited a first outpatient dermatology appointment, of whom 14% had waited > 2 years. By September 2023, this increased by 64% to 359 763, with 29% waiting > 2 years. With growing pressures to prioritize timely assessment of suspected cancers, routine waiting lists are not seen as a priority. We sought to explore novel ways of addressing this via a multifaceted enhanced validation programme, to increase efficiency by ensuring the right patients were seen at the right time. Between October 2020 and February 2022, 5140 patients on the waiting list were contacted via post and text to confirm whether an appointment was still required. This resulted in 33% (n = 1710) being discharged, yielding potential savings of £427 500, as the average appointment cost was £250. Duplicate referrals were reviewed, revealing that long-waiting patients were more likely to have duplicate entries due to multiple referrals or secondary diagnoses. Of 481 duplicates reviewed, 50% (n = 239) were merged into single appointments, saving an additional £59 750. Enhanced clinical validation included the addition of dermatology nursing staff using standardized flowcharts and scripts to contact patients. Patient contact details were cross-checked between databases and electronic healthcare records (EHRs) to correct discrepancies. EHR reviews determined whether the referring conditions had already been addressed. Patients were contacted to confirm whether they still required dermatology input, without providing clinical advice. Those no longer requiring dermatology input were discharged, allowing patients warranting review to be prioritized. Of 600 patients validated, 25% (n = 150) were discharged, saving £37 500, primarily because their conditions had resolved. Feedback received from staff and patients was positive. Staff felt valued and team morale was enhanced by contributing to improving patient waiting times, while patients appreciated being kept informed via communication with clinical teams. Overall, this initiative showed a clear positive impact of enhanced validation in reducing waiting-list numbers, thereby providing significant cost savings. The process required minimal technological input and consultant oversight. Staff who were unable to work in patient-facing roles felt they were making a difference, thereby improving productivity of the service. Updating patient contact details as part of validation also meant correspondence could be sent to correct addresses, reducing the likelihood of patients not attending scheduled appointments due to miscommunication. Moving forwards, enhanced validation could be expanded to other outpatient services, although dedicated resources are required to ensure the sustainability of the service.