1. Age-Related Macular Degeneration: Virtual Clinic Pilot
Emily Rose, Service Improvement Manager, Cardiff and Vale University Health Board
Context and Problem
Effects of Changes
The Virtual Clinic Pilot has successfully initiated the new AMD Pathway and 64 patients have been discharged, with ECLO support offered to each patient.
The graph below shows the cumulative discharges completed throughout the Pilot. At Cycle 16, the new Pathway and Discharge Criteria commenced. The Pilot has reined and streamlined the process.
The Age-related Macular Degeneration (AMD) service required a new pathway that allowed patients to be discharged consistently. Currently there is no formal discharge process and the service is reaching breaking point. Following the R-DMAIC-T methodology, the AMD team set to improve the AMD Service.
Strategy for Change
Following process mapping and analysis, observations and discussions with other Health Boards, a new AMD Pathway was developed, including a Discharge Policy and Process.
A Virtual Clinic Discharge Pilot was developed with all stakeholders including Optometrists, the Eye Care Liaison Officer, Nurses and Photographers, to start implementing the new pathway.
This Pilot focused on patients who had not received treatment in the last 12 months; as the New Pathway was being implemented.
The Process was documented as the ‘Plan’ part of the Plan, Do, Study, Act (PDSA) and shared with everyone within the process. Once a cycle was complete, we would study the process, adapt and update, ready for the next PDSA Cycle.
The Pilot commenced on 10th March 2017 and for every weekly Virtual Clinic a new PDSA cycle would commence as different patients would attend. This allowed for quick feedback and adjustment to be made and tested the following week. Issues were highlighted around the information the Secretary had; adapting the content of the letters handed to patients explaining the discharge process; creating a check list; and simply ensuring the process was being adhered to each week by all involved.
The graph below shows the impact the Pilot has had across all
AMD Clinics, as more patients are now being discharged back to
Primary Care with the right support and information in place.
Pilot Start
Measurement of Improvement
105 Patients were identified as eligible for discharge within this Pilot. To date, 16 complete PDSA cycles have been undertaken. Before and after each Virtual Clinic, there is a short brief and de-brief to gather staffs’ thoughts on any new cycle amendments and also what went well and what needs changing and the process has been refined. On the 6th Cycle, a full review was undertaken to look at how to make the process sustainable with the new AMD Pathway.
The PMS electronic system will be used to identify patients who under the new pathway should be considered for discharge; this will trigger the AMD staff to commence the discharge procedure as refined during this pilot.
Lessons Learned
Multiple PDSA cycles ensures processes are refined and changes can be made quickly
Regular check-ins with staff helped ensure the Pilot went as planned
Sharing the PDSA demonstrates how the Pilot is progressing, ideally a notice board everyone can see should be used for this
Face to face discussions with every member of staff helps ensure feedback and ideas are captured
Clinic Coordinator: “the process is much clearer and patients are happy to be discharged with the right support”
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