Assessment and Patient Pathways

1
Assessment and Patient Pathways

• Geoff Bardsley
• Consultant Clinical Scientist
• Head of Assistive Technology,
• NHS Tayside.

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Summary

• Rapid Improvement Event
• Background
• Scope
• Strategy for improvement
• Planned developments
• Patient pathways
• Assessment issues
• Conclusions
• Stimulate discussion

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Rapid Improvement Event (RIE) ?

• Management technique
• Problems identified with a service
• Step change improvement to a service
• Focussed on meeting client needs
• Re-design actively involves
• Clients
• Staff
• Management
• Action plan
• External consultants

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RIE Background

• Increasing demand
• Improving technology
• Increasing patient expectations
• Budget limitations
• Ending of short term funding
• Changing Childrens Services Fund
• Waiting list initiative
• Short cuts to meet demand
• Assessment
• Staff training support

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RIE Background

• Complaints / dissatisfaction
• Lengthening waiting lists
• Poor control / organisation of waiting lists
• Poor information to patients
• Deteriorating quality of service
• Low staff morale

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RIE Scope

• Entire service
• Pathways
• Emphasis on clinical front end

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Client focussed

• Patient
• Carer
• Referring professionals

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Strategic direction

• Improve the speed and efficiency
• patients are seen
• equipment provided
• Make best use of current staff
• experience and expertise (internal external)
• Make the service to users more
• local,
• responsive,
• transparent
• Improve integration with other services
• etc

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Examples of planned improvements

• Note others

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Patient Pathways
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Patient Pathways

• Summary path

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Patient Pathways

• Defined before RIE (extensive work)
• Few inefficiencies / redundancy
• Largely unchanged
• Further work
• RIE - Referral pathway modified
• Improve efficiency
• Better management / flow of work
• Waiting time information for patients

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Referral Pathway
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Referral Pathway
WT Waiting times
WT lt 1 day
WT lt ?
WT S
WT X
6 lists WT ????
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Referral Pathway
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Referral Pathway
WT Waiting times
WTltltP
WT lt 1day
1 list WT H
WT P
WT S
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Next steps

• Active monitoring / management process
• Routine weekly meetings
• IT data (new reports in place)
• Reporting to higher management
• Staff recruitment
• Transitional phase
• Managing backlog

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Assessment phase

• Clinic inefficiencies
• Did not attends (DNAs) -
• 20 to 40 (1 or 2 out of 5)
• Clinic frequency inadequate
• Waiting times increasing
• Minimise seeing patients
• Review frequency low
• Quality of assessments ?
• Reduced time / patient
• Reduced TORTC team (1)
• Reduced local staff involvement
• No outcome measures

Currently up to 12 wks (clinic) Draft standard
Ref assess lt 4 wks RIE Target Ref
provision lt 18 wks
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Reducing DNAs (Did not attends)

• Pre appointment phone calls
• Patient-focussed-booking (Clinic repairs)
• Letter to patient inviting to book appointment
• Patient responsibility to phone book
• Patient chooses suitable time (More certain will
  attend)
• Excludes those not interested
• BUT disadvantages less able
• Transportation / ambulances ?

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Clinic Frequency

• Increase staff for clinics
• Staff recruitment
• Additional staff
• Utilisation current staff ?
• Increase technicians clinical role
• Concentrate clinical staff on clinics / complex
  cases
• Improve quality of assessment

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Technician utilisation

• Mobile Technicians (x3)
• Current role
• Repairs, collects deliveries
• Travel throughout Tayside
• 5 to 12 years experience each
• Know patients very well
• No clinical responsibilities

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Additional Technician Role

• Empower for basic clinical decisions, Egs
• Change of wheelchair size
• Additional accessories (headrests, laterals, etc)
• Make adjustments (roho cushions, etc)
• Rapid (during repairs / on request)
• Training, Supervision, Backfill
• Ears / eyes of the service
• Tele-care (lap top, camera, phone)
• Better use clinical staff
• Other technicians

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Additional Referrers RoleNurses, Therapists

• Empower for basic clinical decisions, Egs
• Prescriptions (basic cases)
• Local environmental issues (access, ramps,
  house mods, etc)
• Larger wheelchair
• Additional accessories (headrests, laterals, etc)
• Make adjustments (roho cushions, etc)
• Training in wheelchair use
• Training, Supervision,
• Availability?
• Better use TORTC clinical staff
• Work with technicians
• More local service

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One stop clinics
Rapid service Avoids delivery BUT Clinic
time Stock available
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Review procedures

• Referrals for life BUT needs change (slow
  rapid)
• Review to identify change and respond
• Preferably before need critical (pro-active)
• Currently
• Annual letter
• Children a few critical cases
• Future ?
• All have defined review programme
• Resources? (creates extra demand)
• Responsibility of Patients / Carers ??

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Conclusions

• Patient pathways have been defined
• Referral pathway improved
• More structured clinics
• Improved management of waiting lists
• Better information to patients
• Assessment improved / accelerated
• Staff utilisation (technicians, therapists /
  nurses)
• One stop clinics
• Better use TORTC clinical staff
• Reviews ?