New to Follow Up ratios Cardiology Service Improvement Project

1
New to Follow Up ratios Cardiology Service
Improvement Project
CSI Mansfield !
2
What we found

• Set up project team and found problems and
  solutions
• Big problem - Hospital cancellations 5398 per
  year Now 300 cancellations predicted per year
  (Sickness)
• 16 medical staff on call
• 18 medical staff annual leave
• 19 medical staff unavailable

3
What we did

• Partial booking of follow up patients
• Enforce access policy
• Reduce DNAs
• New to follow up ratios

4
Partial booking
Kings Mill to Cancel 3000 Cardiac out patients
Appointments  But dont worry, it is for a good
reason.  Outpatient appointments are lost every
day due to cancellations by the hospital, and
patients who do not turn up. This costs your
hospital 1.52 million a year. This would buy
214 heart bypass operations or 511 pacemakers or
66 nurses and leads to patients waiting longer
for their appointments.

• Publicity
• Cancelled all patients 3,000
• Devised letters
• Flexible slot management
• Electronic OPD request form reduced phone calls
  by 80 per month

5
(No Transcript)
6
Assumptions/reality

• Thought it would take 1.5 days clerical staff to
  cancel patients
• Thought it would cost 6,000 printing postage
• Thought it would take 37 admin hours to maintain
  service

• Took 4 days
• Not costed
• Took 37 hours for pilot will take 21hours for
  continuation

7

• More flexible slot management-need to get away
  from set booking patterns. Need news to be less
  than 6 weeks
• Not many patient complaints (3)

• Need to stick to 6 weeks not 6 weeks and 1 day!
• Need a system to cope with FU DNAs
• Drs and patients have 1 person to speak to
  regarding the OPA

8
DNAs

• 5 DNA for new patients
• 10DNA for follow up patients
• Publicity campaign
• Text reminding (soon)
• Partial booking

9
PATIENTS PATHWAY
DATA QUALITY, BOOKING PATTERNS, DATA QUALITY,
DIAGNOSTIC TESTS, DATA QUALITY, RECONCILIATION
SLIPS, DATA QUALITY, CASE MIX, DATA QUALITY, NEW
TO FOLLOW UP RATIOS, DATA QUALITY, COMMISSIONING
LEVELS, DATA QUALITY, CONSULTANT LEAD?, DATA
QUALITY, OR NOT?, DATA QUALITY.
10
New to follow-up ratios

• Sub project to examine issues surrounding above
• First view showed a ratio of 13.5
• Wide variation
• Many factors to be taken into consideration

11
3 main factors

• Benchmarking
• Case mix
• Data collection

12
Benchmarking

• Looked for a national average (13)
• Planned to contact hospitals with similar
  population type for comparison
• Method used to identify hospitals
• Squared Euclidean Distance (ONS)
• Based on 42 variables within ONS main
  classification, but health areas may be
  geographically far apart

13
CLOSEST HEALTH AREAS CORRESPONDING TO MANSFIELD
DISTRICT (By PCT)
14
Results

• Wide variation, even in the same Trust
• Definition of diagnostic test
• Data submitted
• How calculated
• Not going to work as a benchmarking exercise

15
Case mix

• Hugely important in the context of the difference
  between a DGH and tertiary centre
• Important correlation between number of follow
  ups and length of employment
• Nature of illness means more follow ups over time
  (heart failure, valvular disease etc)

16
Data collection

• Huge area of conflict
• Data collected on Consultant lead OP activity and
  reported to DoH
• This data is used to calculate New to Follow up
  ratio. At start 13.5
• Major inconsistencies between Trusts
• ie

17

• Echocardiogram
• Trust 1- Technician lead therefore not used for
  new to follow up calculation
• Trust2 Consultant lead, and is included
• Echocardiogram diagnostic test.
• ? Should not be confused with an OP attendance or
  used for the calculation
• There were several other issues as well!

18
(No Transcript)
19
Results

• Data re-examined, ratio re-calculated
• New ratio 12.58 for the specialty aggregating
  figures for all Cardiologists
• To be continued..!

20
2 FINAL THOUGHTS..
21
NAFOF
22
(No Transcript)
23
Thank you

• Sally.dore_at_sfh-tr.nhs.uk
• Rhuari.pike_at_sfh-tr.nhs.uk
• www.tcn.nhs.uk