partial booking follow ups
TRANSCRIPT
Partial Booking of Follow UpsPartial Booking of Follow Ups
LINDA PITCHFORDPATIENT SERVICES MANAGER
CLINIC ADMIN & BOOKINGKING’S MILL HOSPITAL
BackgroundBackground
Project CSI has been working to provide solutions to achieve 18 weeks access from 1st referral to treatment in cardiology.
One of the solutions that came from the CSI project team was to partially book follow up outpatient appointments.
Why did we need partial booking of Why did we need partial booking of follow ups (PBFU)?follow ups (PBFU)?
Consultants unable to follow up patients in a timely fashion according to clinical need.
Fixed outpatient appointment system was being driven by the demand for first outpatient appointments (new appointments).
Follow up outpatient capacity was squeezed so that patients were seen long after their ideal review date, often experiencing appointments being moved forward due to clinic cancellations.
Without a Crystal Ball…Without a Crystal Ball…
In traditional fixed appointment systems, patients make their follow up appointment at the end of their outpatient visit, commonly 3, 6 or 12 months in the future.
This can lead to high DNA and cancellation rates, as well as to lots of rescheduling every time an outpatient clinic is cancelled or reduced due to consultant or staff annual leave, study leave, or on-call commitments.
Without a Crystal Ball…Without a Crystal Ball…
Between 1 December 2004 and 30 November 2005 there were 5397 cancellation events within the cardiology outpatient service. 4092 of these cancellation events occurred more than 6 weeks before the appointment date.
1305 of these cancellations occurred less than 6 weeks before the appointment date.
Objectives of introducing Objectives of introducing PBFU PBFU
To dramatically reduce cancelled appointments (hospital and patient driven) .
To increase patients choice.To reduce follow up DNAs. To flexibly plan capacity, with follow up
demand as the driver.
Objectives of introducing Objectives of introducing PBFUPBFU
Improve cost efficiency - reducing the volume of staff resource required to cancel/change clinics.
Ensure follow up patients are seen when clinically appropriate and in broadly chronological order.
Objectives of introducing Objectives of introducing PBFUPBFU
Improve co-ordination of tests/investigations and follow up appointments.
Increase outpatient capacity to support the achievement of 18 weeks end-to-end wait.
ImplementationImplementation
Additional resources - one off allocation of 3 clerical staff for 4 days. - postage and printing costs of £6000 (offset by
future savings from fewer cancellations. - £2000 to support the service at Newark
Hospital.
Reallocation of resources - to support the service at King’s Mill Hospital.
ImplementationImplementation
Go live date set.Publicity campaign, hospitals and local
media.Almost 3000 appointments cancelled.Less than 10 patient complaints.
ImplementationImplementation
Multidisciplinary slot management meetings every 2 weeks.
Policies and procedures reviewed and updated accordingly throughout pilot period.
Electronic OPD request form reduced phone calls by 80 per month.
How PBFU worksHow PBFU works
Patients requiring follow up more than 6 weeks in the future are partially booked.
Patients are given a leaflet.Patients are added to a review list on
PAS with a review date.6-8 weeks before the review date a
letter is sent to the patient, inviting them to telephone to arrange an appointment.
How PBFU worksHow PBFU works
Non responders will be telephoned and if no contact is made the case is referred back to the consultant.
Consultant decides to discharge or refer back to GP.
EvaluationEvaluation
Evaluation took place in November 2006. The success of PBFU was measured against
the original objectives identified by the CSI project team.
Level of DNAs. Patient experience - level of complaints. Consultant and Out patient Dept. experience.
Benefits - Benefits - the Booking Manager’s perspective. the Booking Manager’s perspective.
Our service is more responsive to demand and less bound by inflexible clinic booking rules, we can adjust the number of first outpatient and follow up outpatient slots as necessary.
We can manage a regular flow of responses to match capacity and demand.
We can take decisions about how to allocate resources in a more realistic time frame.
Benefits - Benefits - the Booking Manager’s perspective. the Booking Manager’s perspective.
Demand management is now driven by the total demand in the system. Not just by first outpatient appointments.
Some extra capacity has been added as ad hoc clinics although this will be unnecessary once the new system is fully established.
Remaining capacity is pooled on Choose and Book as first outpatient slots.
Benefits - Benefits - the Booking Manager’s perspective. the Booking Manager’s perspective.
This system of slot management will avoid under booking of clinics due to unfilled 1st outpatient slots, as could happen in the previous system.
Every 6 weeks the service will have a “clean sheet” in terms of clinic bookings.
Partial booking assumes that the majority of patients who currently DNA will not respond to partial booking, hence fewer slots will be wasted, increasing capacity in the service.
Benefits – Benefits – the patient perspective.the patient perspective.
I feel more involved. I am advised of the total waiting time. My appointment doesn’t keep being moved. I am able to choose a convenient time for me
to attend. I am able to confirm my appointment
approximately four to six weeks in advance.
Benefits –Benefits –the Cardiologist’s perspective.the Cardiologist’s perspective.
It’s very helpful to have a dedicated contact person with regard to booking cardiology clinics. And this is the same person that the patient is speaking to.
I am now better able to manage my patients, with follow ups at a clinically appropriate time.
MOVING ON:MOVING ON:From the pilot we learnt the following –For 250 slots per week• 1½ minutes per telephone call = 6.25hrs• One day to work out capacity and send letters out to
patients = 8hrs• Processing notes and pulling for non responders =
4hrs• 2 minutes per patient calling non responders = 1hr• 1 hour per day for daily planning of capacity = 5hrs• 1 hour per week to add ward discharge patients to
pending list = 1hr
TOTAL HOURS 25.25/250 patients/weekHence 10 patients per hour of staff
We are now live with the following specialties: Cardiology ENT Endocrine Gynaecology Urology
With plans to go live in Gastroenterology and Rheumatology within the next few weeks.
We have a staff complement of 6.03 wte and are considering the implementation of call centre telephony.
"Here is Edward bear coming downstairs now bump, bump, bump, on the back of his head, behind Christopher robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it."
AA Milne’s classic, Winnie the Pooh.
