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Name Oisin Friel Location Ryde Drug & Alcohol Services Pretreatment dropout from outpatient substance abuse clinic.

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Presentation on theme: "Name Oisin Friel Location Ryde Drug & Alcohol Services Pretreatment dropout from outpatient substance abuse clinic."— Presentation transcript:

1 Name Oisin Friel Location Ryde Drug & Alcohol Services Pretreatment dropout from outpatient substance abuse clinic

2 Mission Statement Project Aim:  Reduce the number of clients by 25% who fail to attend for scheduled first appointment Time frame:  Proposed commencement date:7/07/08  Anticipated completion date: 7/09/08  Date of Review of Outcomes of Project: 8/12/08

3 Team Members & Role Guidance team member: Oisin Friel Project team members with fundamental knowledge and who worked on the project:  Oisin Friel,  Sue Weston,  Linda Miller,  Barbara Jane Murray,  Loretta Elkins,  Karen Hanzal-Jones

4 Evidence for there being a problem worth solving  An monthly audit was conducted of clinician’s diaries for 2007 to determine the number of kept appointments in relation to scheduled appointments arranged for new clients to the service.  380 allocated appointments of one hour duration were reserved for new clients from January to December. The study revealed a 33% ‘failed to attend’ rate in the twelve month period.

5 Failed to attend rate 2007 (33%)

6 Evidence for there being a problem worth solving Clinicians experienced frustration due to:  Time wasted waiting for client to attend appointment  Uncertainty about why clients failed to attend appointment  Inability to attend to other work responsibilities  Difficulty in organising work diary events

7 High Order Flow Chart of Intake Process Development of drug problem Inability to resolve problem Decision to consult GP GP confirms problems is serious Referral to D&A service Contact D&A service See clinician for assessment Receive treatment Follow up careDischarge

8 Detailed Flow Chart of area of Interest Client contacts service Speaks to intake officer Client given service details, date, time etc Appointment typed into computerised diary Appointment made with clinician Completed intake form filed Leaves message on voice mail Service returns call x 2 Message left Confirms client’s request for this service Intake form completed Check for next available appointment Client arrives / CTC / FTA If other service requests appointment client must call to confirm Client calls to confirm If CTC new appointment arranged

9 Process Improvement Exercise Brainstorming possible reasons for problem Multivoting All team involved Group similar ideas / concepts together Secret ballot voting to choose biggest problem areas Represent as Ishikawa diagram (fishbone)

10 Cause and effect diagram Other Co morbid problems Cognitive ImpairmentExternal agencies Client fails to show for appointment Family / Money Forgot appointment Psychosis Motivation Too hard Couldn’t be bothered Partner forbade it No one told me Too busy Had another appointment Too wet Too cold Drug, alcohol affected Too awkward to find place No money to get there Too unwellDidn’t write appointment down In jail / hospital Assaulted Problem resolved Coerced Got new job Self harmed Slept in Scared Anxious Shame Crisis passed Not ready Got date/time wrong Confusion No transport Missed the bus Kids sick

11 Pareto Analysis Sheet CategoryFrequencyPercentageCumulative % Shame/fear926 Lack of motivation 82248 Forgot appointment 61765 Overslept51378 Co morbid problems 41189 Crisis passed 411100 Total36

12 Pareto Chart Reasons for failure to attend scheduled appointment

13 Intervention Clinicians to call clients prior to assessment date to: Introduce oneself to client Confirm appointment date and time Develop initial rapport Alay anxiety about coming to service

14 Intervention Implementation period: Two months All clinicians involved Data collected by admin assistant APPOINTMENTS SCHEDULING LOG (7/7/08 – 7/9/08) Client Identifier Date of Client Call Date of Scheduled Appointment Did Client keep Appointment? If CTC date of new appointment Did Client keep Appointment? 12/7/088/7/08Yes 22/7/088/7/08No 15/7/08 Yes 33/7/089/7/08Yes

15 Outcome of Study

16 Strategies to Sustain Improvement Incorporate the changes made into the intake process Alter the method by which clinicians are notified of new clients placed in their computerised diaries so as to alert them to call the client prior to appointment time Monitor strategy on a monthly basis

17 Other PDSA Cycles to consider Reduce the lag time to first appointment Monitor dropout rate post assessment Record reasons clients give for cancelling appointments Stay linked to the ACTION Campaign ( to review into addiction treatment improvements

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