Aneurin Bevan UHB faced some difficult choices especially after the Pandemic. The number of patients on the waiting list for EMG and NCS has increased dramatically. To efficiently validate the EMG and NCS referrals for the longest waiting patients, we came up with an innovative way of verifying them. In addition to a more stringent approach to triaging the electronic referrals, we set up face to face triaging clinics. We allocated a 10 minute slot per patient, with the objective to determine as to whether the patient was still requiring an NP input. From January 2025 to December 2025, 13 F-2-F triaging clinics were conducted, with 280 patients assessed.
The 10 minute review consist of history taking, a focused neurological examination, a review of relevant documentation, and pathology and neuroimaging. The outcome of the clinic is discussed with the patient. The outcomes were grouped as:
1. Discharged.
2. Allocated into urgent EMG clinics within 2 weeks, and routine 8 to 12 weeks.
3. Allocated into Physiologist led clinics within 8 to 12 weeks.
23 patients had their EMG/NCS performed on the day.
92 patients were discharged from the NP waiting list.
31 patients had their NCS with physiologists led clinic.
19 patients did not attend and were therefore discharged.
Brief information with outcomes, was entered in the outpatient note for each patient on the clinical workstation. Typically, patients were accepting of the arrangements, even those patients who were discharged without NP input. The rationale behind the decision was discussed with all patients. The referrers were receptive also based on feedback.
When triaging referrals, we have moved away from using the term "rejecting" to "specialist advice", as friendlier, more constructive and overall beneficial for patients' care.
Along with the new approach to triaging using newly developed ANS-BSCN triaging guidelines, the face-to-face triaging clinics have proved to be an efficient method of validation. Not only has it been efficient for the old historical referrals, but is also useful for the current referrals, where the degree of uncertainty regarding patients’ diagnosis is high. This is especially useful for the referrers who do not necessarily have sufficient expertise in managing neuromuscular disorders.
As a result of this new approach, the number of patients on the EMG/NCS waiting list has decreased from 1700 to 200.
I would like to acknowledge Dr Jeremy Bland for his invaluable guidance in shaping this project.
