Authors (including presenting author) :
Tang WK(1), Chan CCC(1), Kam WKI(1), Chan LF(1), Wu HY(1),Or PNB(1), Lam WMT(1)
Affiliation :
(1)Department of Psychiatry, Prince of Wales Hospital
Keyword 1: :
Psychiatric SOPD
Keyword 3: :
Primary care
Keyword 5: :
Workflow redesign
Keyword 6: :
Continuous quality improvement
Introduction :
Escalating demand in the Psychiatric SOPD necessitates the strategic downstreaming of stable patients to Primary Care (FMC/GOPC) to release capacity for complex cases. While automated screening tools (CDARS) exist, they often lack the sensitivity to detect psychosocial nuances. We designed a clinician-led screening workflow to identify suitable patients for step-down, PRN follow-up, or case closure with maintained safety.
Objectives :
(1) To implement a safe AC–led outpatient screening workflow for downstreaming stable patients; (2) to quantify the impact on specialist clinic capacity; and (3) to evaluate the performance and limitation of the CDARS list.
Methodology :
A 3-month prospective CQI pilot screened a total throughput of ~1,700 clinic attendances via two parallel routes: Manual AC Review (screening trainee lists) and CDARS Query (filtering for common mood disorders, excluding SMI/high-risk medications/ substance use disorder/ recent psychiatric admission). A target cohort of 230 cases underwent AC assessment for stability, specifically excluding psychosocial complexity and risk. Recommendations were documented in the CMS and highlighted by clinic nurses on the work sheet. Final decisions were confirmed by CMOs during consultation after clinical assessment and discussion with patients. Newly referred patients were also screened after their first visit. We recorded final disposition, FM/GOPC appointment status and any reactivation of SOPD follow up. A sub-audit (n=104) compared CDARS flags against clinical decisions.
Result & Outcome :
Of 230 screened cases, 169 (73.5%) were deemed clinically suitable. 110 patients were successfully optimized (65.1% of suitable pool): 88 patients were stepped down to FMC/GOPC (with 86% having confirmed bookings), 20 converted to PRN follow-up, and 2 cases closed. Primary reasons for retention (n=59) were patient refusal or clinical deterioration. Zero de-loaded cases required reactivation during the pilot. Operationally, this initiative releases ~330 follow-up visits annually, equivalent to redirecting ~10 full clinic sessions (30 consultation hours) potentially to complex cases or new cases intake. The sub-audit revealed CDARS demonstrated high false positives, with 45 of 80 flagged cases rejected by the AC due to complex psychosocial factors or medication risks. Conversely, false negatives highlighted that current diagnosis filters missed suitable anxiety-spectrum cases. Automated screening alone is insufficient for safe psychiatric downstreaming due to its inability to detect psychosocial instability. A Clinician-Led "Active Filtering" model provides superior safety and operational yield. Future cycles will focus on upgrading CDARS logic to capture missing diagnoses, allowing for a sustainable transition from manual screening to a refined automated model with a safety gate.
