Reinventing the outpatient clinic: piloting a multi-consultant model for non-melanoma skin cancer to improve efficiency and reduce wait times

Introduction: Queensland is home to the highest incidence of non-melanoma skin cancer (NMSC) in the world. Consequently, referrals often exceed the treatment capacity of plastic and reconstructive surgery (PRS) resources concentrated in metropolitan centres. In response to prolonged outpatient wait times, a multi-consultant outpatient clinic was piloted at a tertiary Queensland PRS centre. Objective: To evaluate throughput, attendance, wait-time characteristics and surgical outcomes of a multi-consultant NMSC outpatient clinic. Methods: All patients with biopsy-proven NMSC who attended a dedicated, multi-consultant PRS clinic were included in the study. Seven consultants, each allocated two rooms, reviewed patients in parallel, with surgical trainees and nursing staff preparing the next patient in the adjacent room. A centralised queue allowed dynamic allocation to the next available consultant. Patient and lesion demographics, treatment decisions and surgical outcomes were recorded on a standardised proforma. Results: Of 166 scheduled patients, 155 attended (93.4%). Patients (n = 155; 209 NMSC lesions; 25.8% with multiple lesions) were predominantly elderly (median 74 years) and male (67.7%). Lesions were mostly basal cell carcinomas (135 lesions, 64.6%) over squamous cell carcinomas (56 lesions, 26.8%). The majority of lesions (169, 80.1%) were located on the head and neck. All patients were assessed within three hours and 15 minutes, equating to approximately 48 patients reviewed per hour. Median time from biopsy to PRS consultation was 150 days, while median time from consultation to surgery was 45 days. Complete excision was achieved in 95.8 per cent of cases. Conclusion: The multi-consultant clinic allowed rapid specialist assessment of 155 NMSC patients within a single session, addressing the outpatient consultation bottleneck in high-volume tertiary centres. This model warrants evaluation as a scalable strategy to reduce specialist outpatient waiting lists.