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.