WHAT WORKS FOR US AT YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST

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WHAT WORKS FOR USAT YEOVIL DISTRICT HOSPITAL NHS
FOUNDATION TRUST
Dumiso Ncube General Manager for Surgical
Specialties
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The Yeovil Philosophy

• More of the same does not work
• Needs to be led by existing staff
• Must have patient and public involvement
• 18 weeks is the beginning not the end

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What We Have Achieved So far

• Over 90 of patients both admitted and non
  admitted treated within 18 weeks
• Same day plain x-rays drop in service
• Zero waits for echocardiography
• Raised morale and pride of staff

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CASE STUDY 1 RADIOLOGY
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Waiting Lists Summer 2005

• MRI Scans 22 weeks
• Ultrasound Scans 16 weeks
• Barium Studies 12 weeks
• Plain Films 12 weeks
• Nuclear Medicine 8 weeks
• CT Scans 6 weeks
• Dexa 22 weeks

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Service Re-design

• Undertake capacity and demand study of all
  modalities
• Set up service team consisting of each modality
  superintendent radiographer
• Send out 2 questionnaires, 1 to patients and the
  other to internal service users inviting
  suggestions of improvement
• Staff communication

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Actions Implemented

• Saturday working (9.00am 5.00pm)
• 4 day working week (MRI, CT, Ultrasound)
• Move private patients to dedicated evening slots
  (staff paid separate fee)
• Utilise spare capacity at community sites (plain
  films and Ultrasound)
• Protocol drive unsupervised CT / MRI examinations
• Extended roles (Bariums, Ultrasound, reporting
  etc)
• Implement Radiology Waiting List Policy
• Increase use of One Stop Clinics

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Radiology Waiting List Policy

• Internal waiting list of maximum 4 weeks for all
  modalities
• Use of telephone bookings where possible
• Maximum of 3 week patient delay for holidays etc
• DNA one strike policy
• Form vetting undertaken by modality
  superintendent
• Modality waiting lists checked every week for
  potential breaches

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Current Waiting Lists

• MRI Scan 3 weeks
• Ultrasound Scan 3 weeks
• Barium Studies no waiting list
• Plain Films walk in service or Saturday
  appointment
• Nuclear Medicine 2 weeks
• CT Scans 2 weeks
• Dexa 3 weeks

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CASE STUDY 2 MEDICINE
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What We Changed

• Use of Nurse Specialties who sees and who does
• Demand and capacity matching staffing to demand
• Pre-appointment diagnostic tests
• Additional resources for specific groups of
  patients that come for regular follow-up

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Who Sees and Who Does?

• Implementation of nurse led follow up clinics for
  heart failure in Cardiology
• Nurse specialists undertaking diagnostics and
  initiation of treatment in conjunction with
  consultants in Respiratory Medicine
• Technician led follow up for routine
  echocardiography

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Matching Staffing to Demand

• Review of staffing levels for diagnostic services
• Changed staffing structure in Clinical
  Investigations Department to address long waiting
  times for specific tests
• Reviewed annual leave in departments to ensure
  that cross cover arrangements were in place to
  minimise loss of lists

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Pre-appointment Diagnostic Tests

• Patients now attend for diagnostic tests in
  advance of their outpatient appointment (eg
  echo, blood tests)
• Consultant has information in advance of
  appointment order to be able to start treatment
  at first consultation (if appropriate)
• Reduces the need for follow up appointment

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Additional Resources for Specific Patient Groups

• Large numbers of patients with long term
  conditions
• Appointed new Nurse Specialist for Inflammatory
  Bowel Disease to undertake follow up clinics
• Patients have a single point of contact and
  releases capacity in consultant clinics

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Sign Up from Staff

• 18 weeks regularly discussed at consultant
  meetings
• All staff involved early in the process of
  development
• Encourage all staff to use outcome forms (helping
  to track patients)
• Allow staff to come up with their own ideas
• Use a bottom up not top down approach

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• CASE STUDY 3 SURGERY

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18 Week Menu
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Actions Taken

• Extended Roles
• Nurse Led Clinics
• Audiology Assistants
• Nurse Colposcopist
• Nurse Endoscopist
• Optician Led Clinics
• Nurse Led Arthroscopy Follow up

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Actions Taken (continued)

• Process Re-Design
• Non vetting of referral letters
• Direct listing
• Booked operating lists
• Telephone Consultation / Follow-ups

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The Answer is Clinical Balance

• Diagnosis and treatment
• Clinic time and operating time
• Do not see more patients that you can treat
• Conversion rates vary between specialities and
  individuals, so job plans have to vary
• Moving patients between consultants will lead to
  unhappiness

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The Process

• Identify types of referral (large numbers) that
  can be standardised. You can have as many
  pathways as there are patients!!
• General and specialist clinics (single visit
  preferred)
• When you have balance excise the tails (a messy
  business)

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The Process (continued)

• New appointments gt new referrals
• Minimise named referrals (generic), refer to
  clinics not doctors
• Balance consultant job plans
• Single handed ologist is unhelpful

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• SUMMARY

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What Was Learnt?

• Do what suits team
• No magic formula / nothing new
• Understand all processes / pathways
• Re-design / reduce waiting times
• Continuous process

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REMEMBER
See the World through patients eyes