Partial Booking of Follow Ups

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Partial Booking of Follow Ups

• LINDA PITCHFORD
• PATIENT SERVICES MANAGER
• CLINIC ADMIN BOOKING
• KINGS MILL HOSPITAL

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Background

• 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.

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Why did we need partial booking of 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.

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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.

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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.

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Objectives of introducing 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.

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Objectives of introducing PBFU

• 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.

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Objectives of introducing PBFU

• Improve co-ordination of tests/investigations and
  follow up appointments.
• Increase outpatient capacity to support the
  achievement of 18 weeks end-to-end wait.

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Implementation

• 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 Kings Mill
  Hospital.

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Implementation

• Go live date set.
• Publicity campaign, hospitals and local media.
• Almost 3000 appointments cancelled.
• Less than 10 patient complaints.

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Implementation

• 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.

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How 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.

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How 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.

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Evaluation

• 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.

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Benefits - the Booking Managers 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.

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Benefits - the Booking Managers 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.

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Benefits - the Booking Managers 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.

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Benefits the patient perspective.

• I feel more involved.
• I am advised of the total waiting time.
• My appointment doesnt 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.

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Benefits the Cardiologists perspective.

• Its 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.

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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/week
• Hence 10 patients per hour of staff

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• 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.

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• "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 Milnes classic, Winnie the Pooh.

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• We stopped bumping,
• Any questions?
• linda.pitchford_at_sfh-tr.nhs.uk