Transcript patient journey - Quality Improvement Hub

A&C Role
Development
Yorkhill’s MRI Service
Lorraine Peebles, SIM,
Diagnostics, NHSGGC 31 Mar 10
Once Upon a Time……
Concern about MRI department’s ability
to transform its resources effectively to
reduce waiting times for patients
MRI PATIENT JOURNEY
MRI REFERRAL PATHWAY
The Way We Were!
Roles and responsibilities within MRI department blurred –
Radiographers doing A&C tasks (booking beds, theatre time, Anaesthetists/OP
appts and cancelling appts)
Imaging Assistant duties inappropriate (mostly clerical)
MRI reception area not staffed and Telephones on answering machine
Cancelled Appointments not being re-used – capacity being wasted (GA appts)
Referral demand not being managed – eg, no emergency slots identified
Patient clinical and safety information from Referrers often inadequate
No agreed Appointment templates
Data and information being captured in two separate IT systems
Theatre staff, Ward staff and Imaging staff unsure of their responsibilities in relation
to input of data
No joined up working between MRI, Anaesthetics and Day Care
Prospective anaesthetic rotas sometimes unavailable
Over-arching Objectives
1. Seamless, high quality MRI patient
journey for inpatients, day cases and
outpatients
2. Increased throughput and utilization of GA
MRI sessions by managing the referral
pathway and associated data effectively
Tool used : RIE
• Rapid Improvement Events are part of the Lean 'toolkit'
and provide a mechanism for making radical changes to
current processes and activities (patient pathways) within
very short timescales.
"The power of RIEs comes from the combined talents
of cross functional teams being focused on achieving
specific goals in relation to bottom line, operational
improvements"
- Andrew Scotchmar, Data Analyst, East Lancashire
Health Economy
Selling the RIE Tool!
• Why we needed to change
• What did we need to change
• Baseline of the current performance and trajectory of where we
think this new model would take us – 4 weeks!
• High profile executive leadership and management buy-in
• Key Stakeholder buy-in
• Champions within the MRI team to drive the transformation
NHS Institute for Innovation and
Improvement
“Optimising roles along an agreed
pathway of care leads to significant
improvements for staff and patients in
key areas”:
Role Development/Design
Reducing delays in patient journey
Reduction in waiting times
Improve patient services
Tackle staff shortages
Increase job satisfaction by developing and amending
roles
Benefit entire Health Care Team – Support Workers to
Medical Workforce
Improve quality and flow of patient journey
To attract and retain an effective workforce
Approach to RIE
Key Components which together make up the
Integrated Patient Journey
Increased throughput
and utilisation of MRI
Sessions
SEAMLESS
Specialty
Referral
Referral
Access
Managing
Demand
Acquisition
Reporting/
Verification
Report to
Specialty
Referrer
Areas for Improvement
• Referral access
• Vetting
• Acquisition
• Reporting
• Data management
MRI REFERRAL
COORDINATOR
to provide continuity
& work closely with
Supt Radiographer
A&C
HCSW
GA Nurse
Radiographer
Radiologist
No MRI A&C input
Appting patients
on PC and in
duplicate paper
diary
Phoning Wards for
patients
Arranging manual
diary – managing
waiting list
Vetting being done
on an ad-hoc basis
MRI A&C duties
distributed over
main office
Portering duties
CURRENT
SPLIT
Bed/Theatre
Phoning patients
Dealing with
anxious parents
and less time with
patient
Booking
OF DUTIES RELATING
Chasing up
Posting letters and
sending out
checklists
TO THE
Reception duties
Logging of
referrals
referrers re
complex
cases/additional
info
Answering
Supplies Ordering
REFERRAL
PATHWAY
telephone with
Patient
demographics
inadequately
checked and IT
system not
updated
appt changes
AND
Monitoring vetting
Ordering supplies
Safety Checklists
PATIENT JOURNEY
Reception duties
Reception duties
Answering phone
Answering phone
Scanning patients
Constant
interruptions
REFERRAL COORDINATOR
HCSW
GA Nurse
Radiographer
Radiologist
Managing waiting list
More time
with
patients
and carers
Dealing with
Anxious
parents/
patients
Scanning
patients
Vetting
(monitored by
Referral
Coordinator)
Cancelling / reappointing
Monitoring vetting
Chasing Referrers re complex
cases/additional info
PROPOSED SPLIT OF
Bed/Theatre Booking
Assisting
with
transport
of patients
DUTIES RELATING
Answering/filtering phone calls
Phoning Wards for patients
Ordering of
supplies
Phoning patients with appointment
and carrying out Safety Checklist
Checking patient demographics
Posting letters and sending out
checklists
Reception duties
Available
during
scanning
TO THE REFERRAL
Logging & appointing patients on PC
Appointing patients on PC
Administering
contrast
Assisting
PATHWAY
AND
Phoning
Wards for
patients
PATIENT JOURNEY
Telephone
calls filtered
by Referral
Coordinator
Action List
•
•
•
•
•
•
•
Business Case for Referral Coordinator
Business Case for additional GA Nurse
Developed new referral form
Developed new referral access criteria
Developed new referral management process
Developed new inpatient journey from ward
to MRI
Worked with stakeholders to promote data input
Current Landscape – Where are we now?
Clear process &
responsibilities
defined for data
management
Safe, sustainable,
seamless
patient journey
to MRI and back
4 week wait from
referral to report
Joined-up working
between key
stakeholders in
patient journey
Referral Coordinator
Improve MRI staff
morale
and job satisfaction
Maximise MRI
scanner
utilisation
Clear process &
responsibilities
for
Managing referral
pathway
48 hours max
wait
for all urgent
IP referrals
Reduce DNA
rates
to < 4% and
short
notice
cancellations
Appropriate
allocation
of MRI
duties &
responsibilities
Improve on
current
high
quality of service
to Referrers
A&C Role
Development
Yorkhill’s MRI Service
Lorraine Peebles, SIM,
Diagnostics, NHSGGC 31 Mar 10