Pre-October 2008 Main anticoagulation Clinic held in Outpatients Department (OPD) in a 3 hour slot on one day for over 100 patients. Total of 520 registered patients Patients had to queue to check in at the OPD desk, wait for venepuncture, wait for the return of their yellow book with dose record and then queue again to be given their next appointment date Patient turn around time average of 45 – 60 minutes
The waiting room was overcrowded and uncomfortable for this and all other concurrent clinics.
. Appointments were in control of Out patient clerks The clinical needs of the patient were not always taken into account when changing appointments Patient choice regarding appointment times was restricted DAWN v PAS Appointments changed later by patients were only made on the Hospital system causing time consuming problems when managing the DNAs on DAWN –Clinical needs again not taken into account Patients rarely kept to the appointment times as they realised were not relevant to the clinic management Appointments
New patients were seen as part of the same clinic 3 clinic rooms and 3 staff were required to cope with all tasks The instructional video and counselling had taken place at least 3 days earlier thus more reinforcement of the message was required Appointments
Other Problems Reproducing forgotten yellow books Clinic staff working under turn around pressure had little time to listen to patient problems High risk of transcription error of result or dose Patient experience not always with privacy and dignity Hand written labelling on samples Patient Car parking charges Ambulance patients required managing Patients in wheel chairs Relied on KC4 Interface and a different INR method to that used for routine PTs and elsewhere in Trust
Drivers of change Reduce clinic costs to encourage PCT to purchase services – New Nottinghamshire wide LIMS – WinPath with Nottingham Univ. Hospitals had already developed DAWN v7 Standardise on one dosing method across our 2 site Trust with Kings Mill then using Telepath Standardise the Trust wide Prothrombin method Standardise most SOPs, Training and competency 30 GPs did not want to take patients on themselves
What other benefits? Standardise Reports for NPSA Standardise Benchmarking & Audit Standardise patient documentation Improved Clinical Governance Confidence in tried and tested system releasing a Consultant haematologist from clinic duty Flexibility - Maintain ability to have different clinic models and Customise to the two sites
Decision Replace Telepath with DAWN v7 at KMH enabling Newark and any other site to browse to it In House interface developed from our Hospital results system to DAWN –(didnt use WinPath interface) Newark DAWN v6 data & KMH Telepath data transferred to DAWNv7
Taking Control of appointments & Admin. Dawn 7 enabled us to add so many dimensions to our service that we took a complete new look at what we provided and the entire clinic organisation. Main Improvements influencing this: Ability to produce SSTR reports Single sheet therapy records can be printed on either site Dosing support on two sites Automated DNA letter management Other Letter management Use of quick note and coded comments Customisable clinics Ease of use of system – for all staff groups Ease of access to system wherever clinic staff are
POST OCTOBER 2008 Management of the clinic was taken over totally by the Anticoagulation team Specialist haematology Nurse supported by 1 day/week pharmacist Laboratory staff as required New patient clinic Remote Consultant Haematologist
Effect on Newark Patient: Patients adopted compliance with an appointment time culture; persuaded by actual evidence of clear waiting areas Presence of Helpline persuaded them that waiting for the result and dose was not necessary Presence of Anti-coagulant professional in clinic meant they could still seek advice if they needed it justifying GP and patients preference for this clinic model.
Effect on Newark Patient: Initially we provided the option for a patient to wait for their result – expediting their dosage and printing dosage sheet Within 2 months these requests dwindled to zero as they saw everyone else happily leaving
Improvements for the Newark Patient: Improved the entire patient journey Dedicated new patient clinic to view instructional video with counselling followed in a non-hurried atmosphere Reduced impact on patients lives by setting up more clinics and offering choice of timed appointment Provided a dedicated Helpline for patients to receive advice and support and make changes (later) More efficient as staff less pressurised in all clinics
Improvements for the Newark Patient: improved referral & discharge arrangements as same system on 2 sites Reduced waiting list times for new referrals Improved control of clinic appointments which ensures safer practice.
an identified point of contact for patients to seek advice outside of clinic sessions, resulting in consistent support especially for new and anxious patients an identified specialist resource support for the hospital wards to contact (without necessarily using the Consultant haematologist as first point of contact) Consultant still sees identified problem patients at a dedicated appointment Improvements for the Newark Patient:
More secure bar coded sample label Reduced Transcription errors Less pressurised staff are more welcoming Seats available in the waiting area free up 2 consulting rooms in OPD
Improvements for the Newark Patient: Most Patients previously requiring ambulance now bled at home by community staff –slow roll out to keep DN teams on our side Establishment of a non-attenders clinic for their specific management. For remaining few ambulance patients requiring clinic attendance by using a DAWN customised Ambulance report we were able to improve information on booking requirements to for the Ambulance service
Improvements for the Newark Patient: Defining exact requirements of the patient e.g. deaf/poor communicator for ambulance service to inform their crews. Use of coded comment informing patient an ambulance is booked - reassuring Patient Complaints & calls have diminished Cost reduced
Improvements for the Newark Patient: Car park stays of less than 20 minutes are free Patient turnaround now 5 – 20 minutes Pre-October 2008 a patient survey showed the majority of our patients were very satisfied and very few were less than. We intend to follow – up this survey in 2010 to prove we can still keep our patients happy
Dedicated Phone line Available for patients to leave non-urgent messages 24 hours per day receives 90 per month Calls returned by appropriate professional Audit –50% of calls appointment changes