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Lorenzo: A Clinicians Perspective Neil Nevitt Podiatry Team Leader Liverpool PCT Slide 2 Who we are? Community Podiatry service Clinic based sessions Home visits Nail surgery High risk patients diabetes, PVD, RA Biomechanics Self referral system open to all residents of Liverpool Currently- approx 500 clinic/ 180 dom sessions a month Slide 3 Slide 4 Areas for Improvement: Before Lorenzo Accurate understanding of current patients vs total caseload Improved booking and clinic management Waiting list management Scheduling system for home visits Choice Equity Improved accuracy of demographic details Slide 5 As a Team Leader Staff and rota management Availability of Clinic sessions Managing demand Understanding productivity DNAs Identifying opportunities Slide 6 What the Podiatry Service wanted to deliver? Flexibility and choice to patients An accessible, equitable service for all A service that responded to patient need Team that understands its achievements is run effectively. A service with fewer patient complaints Slide 7 Reporting and Information Gathering Then Manual counts Monthly tallies Dependent on individual clinic staff Now Monthly reports Information Team Data quality programme Citywide vs clinic view Slide 8 MonthReferrals Jan-07766 Feb-07602 Mar-07741 Apr-07573 May-07685 Jun-07641 Jul-07584 Aug-07504 Total5096 Slide 9 MonthContacts Jan-073599 Feb-073720 Mar-073825 Apr-073101 May-074058 Jun-074100 Jul-073782 Aug-073924 Total30109 Slide 10 Offering Choice and Managing Demand Slide 11 Every little helps! Reviewing real time clinic management- know what kind of day the team are having- DNAs, walk ins etc! Rota and clinic set up Letter production Slide 12 Clinical Coding: Snomed CT North West Regional Podiatrist Dataset Codes now available Start to record clinical information Diabetics, high risk, nail surgery, orthotics Slide 13 Liverpool PCT Podiatry Service Recording Items for Podiatry Service on Lorenzo CodeTermDescriptionSnomedRelease Reason for ReferralTo be completed at initial appointment for patients with the following conditions only CCRFRPeripheral vascular diseasePatients with PVD CCRFRPeripheral NeuropathyAll patients with peripheral neuropathy CCRFRConnective tissue diseaseEg patients with rheumatoid arthritis105969002MR2 CCRFRHigh risk diabeticHigh risk following assessment394672002FLEM CCRFRIncreased risk diabeticIncreased risk following assessment CCRFRLow risk diabeticLow risk following assessment394671009FLEM CCRFRFoot UlcerAny foot ulcer95345008FLEM Assessment codesTo be used to record assessments during initial & follow up appointments CCASSDiabetic foot risk assessmentFor minimum assessments & annual review394683006FLEM CCASSBiomechanical assessmentFull/ simple biomechanical assessmentCC00030FLEM Treatment & InvestigationsTo be used to note treatment activity at each contact CCTRENail Care ProcedureNails cut and filed313026002FLEM CCTRESharp debridementCallus / corn removal with scalpel CCTREPartial nail avulsionPNA20781004FLEM CCTRETotal nail avulsionTNA183668008FLEM CCTREWound care debridementDebridement of ulcer CCTREWound careSwab, dressing etc of wound225358003FLEM CCTREBiomechanical therapeutic activity Manufacture and fitting of bespoke / adjusted orthotic device & exercise advice 16361000000102MR2 CCTREProvision of orthoticProvision of simple insole or simple orthotic Slide 14 Next Steps Sharing record with Dermatology services Treatment room nurses Compare and share outcome measures Slide 15 Summary Taken 2 years Information Team supporting DQ Just starting to code Looking forward to Summary Record Slide 16 Questions? Contact Details: Neil Nevitt: 07795 370150 Claire Jones: 0151 234 5093