Background & Problem:
The Clinical Haematology outpatient department at Gloucestershire Royal Hospital runs from the Edward Jenner Unit. There are a number of outpatient clinics running throughout the week with multiple clinicians involved. The clinics are generic and will see patients with both malignant and non-malignant conditions, new patients and patients on active follow up. The clinic templates are mostly the same for each clinic and patients are booked by urgency.
It was already acknowledged within the department that the outpatient clinics within Clinical Haematology frequently ran late. This was regularly raised as a concern by both patients and the clinical teams. The causes for this were at the time, thought to be multifactorial with differing opinions as to the route cause and solution. Without any robust investigation the issue continued with no-one quite knowing where to start.
To improve patient flow in Haematology Clinics at Gloucestershire Royal Hospital over a 10 month period by reducing waiting times in Outpatient Clinics.
• Firstly a driver diagram was drawn up to understand the key drivers and generate change ideas
• Collection of baseline data to validate the waiting time issues and understand how long patients were waiting. The audit measured the time of the patient’s arrival, the time they were seen, the length of time spent with the consultant and the diagnosis.
• The results of the baseline data showed that patients were waiting between 30 and 60 minutes past their appointment time to be seen. In addition, that patients were taking longer with the consultant than their given appointment time.
• We utilised PDSA methodology in order to measure the benefits of each change implemented independently of each other.
• The first PDSA, amending the clinic appointment letters to highlight the need for them to attend 45 minutes prior to clinic appointment time to ensure bloods taken and processed prior to their consultation. We also spoke to patients in clinic and offered option of having blood tests taken in the days prior to their appointment as an alternative to arriving any earlier.
• We re-audited clinic and Cross referencing this data alongside patient diagnosis, it showed that patients with Myeloma and those with myeloproliferative neoplasms were over running their appointment times frequently.
• The second PDSA, a clinic template review. This pulled Myeloma patients out of general clinics and into a Myeloma specific clinic with appropriate appointment times alongside a newly established MPN clinic.
• Once this had been established for a month or so the Myeloma clinic was audited to ensure that the right patients were booked into the slots. The main clinic was also reviewed to see if this had impacted on waiting times for other patients. The MPN clinic was not re-audited at that time as took longer to establish.
• Verbal feedback from patients has been very positive.
• Friends and family responses show a reduction in comments regarding long waits for clinic.
• Clinics are now finishing on time or closer to time than they had been.
• Clinics flow better when adequate HCA support .
• The plan is to continue to move towards disease specific clinics to continue the improvement pathway.
• The joined up approach to team working using a mixture of both clinical and non-clinical staff was key.
• Patient survey pre and post changes would have been helpful to reinforce the verbal feedback we have received
• This was a big change to established working practices which meant there were many barriers to overcome; Perseverance and understanding that Change takes time - KEEP GOING...