Presentation on theme: "Anthony Larkins & Judith Swan, Hunter New England Local Health Network"— Presentation transcript:
1 Anthony Larkins & Judith Swan, Hunter New England Local Health Network ENT Express:Improving the Patient Journey through the Royal Newcastle Centre Ear, Nose and Throat ClinicsAnthony Larkins & Judith Swan, Hunter New England Local Health NetworkIntroductionThe Ear, Nose & Throat (ENT) Clinics at theRoyal Newcastle Centre (RNC) deliver asignificant ambulatory care service to around4,500 patients annually. The service wasexperiencing complex problems including:long waiting lists to get an appointment for new non urgent patients;long wait times upon arrival in the clinic;overbooking of clinics;staff frustration; &patients complaints.The Patient Experience: Jo’s Story“I went to my GP because I had a discharge from my ear. I waited for 3 months for an appointment [at the ENT Clinic]. On the day of my appointment I waited for 2 hours to be seen. I returned 6 weeks later for another appointment and went through the same procedure. I had a total of 5-6 appointments each about six weeks apart. I was very frustrated in that I saw a different doctor each time. I arrived for an appointment and had to repeat my story from the start every time. I only saw the specialist twice in 12 months. I felt…rushed after waiting for 2 hours to be seen. When I complained I was told that 3 patients can be booked into one appointment time.”Key IssuesThere is variation in internal processes for bookings and internal flows.There is minimal capacity for non urgent new patients to be seen in the ENT service leading to long waiting lists.There are no clear pathways and criteria articulated to transfer patient care both into the ENT Ambulatory Care service and back to their GP.Key Opportunities for ImprovementThe solutions fall into six clear categories:The key solutions are:1. Patient Centred ServicesReferral pathways for high volume patientgroups with pre defined management andinvestigations where appropriate. Standardisedreferral template for GPs.Criteria for transfer of care back to GPs.Electronic discharge summaries.Information about ENT services are available onwebsite.2. Clinic StructureEquipment and resources availableReorganise clinics to meet patient demandNurse led clinics3. Scheduling / WaitlistImplement clinic template booking to 75%capacity to allow for urgent reviews and postoperative appointments. Monitor compliance ofbookings to template.Waitlist to be regularly reviewed, measured,monitored and processes for action andaccountability to be put into place.Minimise number of cancelled clinics.The associated UWS visual analytics project willdevelop a range of recommendations forimproved processes.To implement these solutions a range of enablerswill need to be considered including training &education and the development of ambulatorycare performance indicators and an associatedcoding system.AimThe purpose of the project was to make recommendations that will ensure a patient centred ENT ambulatory care service that meets the needs of the community.ObjectivesImprove patient satisfaction.Reduce the number of patient complaints.Reduce the number of patients on the waitlist.Improve staff satisfactionFindingsResults from the 2009 NSW Health Patient Survey for Outpatients in the RNC found that patients:ranked the courtesy of the staff very highly.felt the health workers worked well togetherand felt they had enough time with the person.felt they waited too long in the waiting roomand the reason for the delay was not explained.were not able to get an appointment whenwanted.MethodThe NSW Health Clinical Redesignmethodology was used to conduct the projectas shown below.A variety of activities were utilised to diagnosekey issues and identify solutions. Stakeholderswere consulted and patient experience wascentral to the approach. A literature search wasundertaken and leanings were shared with stafffrom The Alfred Hospital Ambulatory Careservice in Melbourne.The following guiding principles (written byHNE Health clinicians) for the development ofnon-inpatient services in HNE Healthunderpinned the solution design phase:Services are delivered as close to home as possible in a caring, efficient and timely way;Care is evidence-based and continuouslyimproving;The elements of care are integrated andcoordinated;Care is supported by appropriate technology;There is a focus on preventative healthcare;Resources are used wisely;There is strong leadership;There is support for staff and their ongoingeducation and training.Project TimelineJulyAugustSeptemberOctoberNovemberDecember123456710981312111415161718192021i. ProjectInitiation & Start-upii. Diagnostic Phaseiii. Solution Design Phase20/9/2010 – 25/10/2010iv. Implementation, PlanningAs of 31 August 2010 there were 1,867 patients waiting for an appointment at the ENT Clinic. The majority of these patients (75%) were triaged as non urgent to be seen within 365 days.Processes are complex. There are 14 major steps (first 5 shown here), just to go from referral to patient arrival in the waiting room. Each step has numerous associated detailed processes and tasks (shown as “+”). Source: University of Western Sydney, Visual Analytics ProjectConclusionThis ENT project has been important to RNC Ambulatory Care services as it provides a key set of leanings that may be applicable for other ambulatory services.The guiding principles have been integral to the project and were well accepted by the clinicians, managers and staff involved.AcknowledgementsTracey McCosker, Director Clinical Operations (Executive Sponsor)Dr Kelvin Kong, VMO, Ear Nose & ThroatProfessor Nikolai Bogduk, Director Clinical Research, RNCTodd McEwan, General Manager, Greater Newcastle Acute NetworkSue Waters, Service Manager/DON Royal Newcastle CentreWendy Pudney, Operations Manager, Ambulatory Care Centre, Royal Newcastle CentreJulie Tait, Service Manager, Division of Surgery John Hunter HospitalJane Gray, Director Innovation SupportA/Professor Terry Sloane, University Western SydneyCathy Grahame, Nurse Unit Manager Paediatric Ambulatory Care John Hunter Children’s HospitalStaff from the RNC Ambulatory Care Service & the Referral Management CentreA/Professor Anneke Fitzgerald, University of Western Sydney (Visual Analytics Project)Dr Joanne Curry & research team, University of Western Sydney (Visual Analytics Project)Contact DetailsAnthony Larkins.Judith Swan.