12 25 PLENARY Reducing turnaround times the impact on users by xVQc3lWw

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									Reducing turnaround times – the
       impact on users
            Dr Saimah Arif
      Consultant Histopathologist
                                                  Days




                                   10
                                        15
                                             20
                                                    25
                                                         30
                                                              35
                                                                   40




                           0
                               5
              C090017755
              H090009117
              H090009145
              C090017937
              H090021038
              H090009293
              C090018141
              N090001769
              H090009377
                                                                        September 2009




              H090009393
              N090001805
              H090009522
              H100000027
              H100000071
              C100000254
              C100000255
              C100000323
              H100000320
                                                                        January 2010




              H100000322
              H100004564




Lab Numbers
              N100001134
              H100004689
              N100001102
              H100004772
              H100004788
                                                                        May 2010




              N100001111
                                                                                                                                          OVERALL TURNAROUND TIME




              C100007809
              N100001124
                                                                                         (specimen collection to electronic validation)




              H100009495
              N100002169
              N100002173
              H100009637
              H100009661
              H100009691
              N100002210
              H100009796
                                                                        September 2010




              H100009814
              C100015024
              H100009907
                                                                 Whipps Cross Hospital
                                                                  Turnaround Times
100.0%
                    In 3 days          In 7 days
90.0%



80.0%



70.0%



60.0%


50.0%



40.0%



30.0%



20.0%



10.0%



 0.0%
         Sep-2009   Oct-2009    Nov-2009   Dec-2009   Jan-2010    Feb-2010   Mar-2010   Apr-2010   May-2010   Jun-2010   Jul-2010   Aug-2010   Sep-2010
           What’s the point?
• Great for histopathology
• Are the clinicians aware and what are they
  doing about it?
• Are patients getting
  – results
  – MDT discussion
  – management plans any earlier?
            User engagement
• Clinical representation on the project core
  team
• E-survey to all hospital consultants, specialist
  nurses and relevant GPs
• Patient involvement
  – Patients’ Panel
  – National Pathology Week
                  Raising our profile
• Project presented at
    –   Executive team meeting
    –   Cancer Strategy Day
    –   Cancer Board
    –   Medical Division meeting
    –   Medical Grand Round
    –   GP Pathology day
• Written about in the
    –    Trust Gazette
    –    Trust Annual Report and Review
•   One-to-one meetings
     Feedback from targeted users
•   Gastroenterology
•   Dermatology
•   Gynaecology
•   Urology
  Are patients getting results quicker?
• Colposcopy results issued within 2 weeks
  – 67% in 1st qtr of 2010 vs 44% in 1st qtr of 2009
• ‘faster appointing into treatment appointments is
  possible...following an abnormal smear patients
  are usually extremely anxious and it is very
  satisfying to alleviate anxiety and reassure them
  at the earliest opportunity’ Nurse Colposcopist
Fewer follow-up appointments?
‘When I see complex surgical patients for
 suture removal at one week, I can also now
 give them their result (including the Moh’s
 patients) and therefore discharge them
 straight away which means one less follow-up’
 Consultant Dermatologist
 25 fewer outpatient slots required per month,
 charged at £60 each to PCT (total £1500)
     Earlier discussion at MDM?
Urology patients with suspected malignancy
  – Biopsied on Friday
  – Discussed at MDM on following Tuesday am
  – Patients given result and management plan
    Tuesday pm
  – A whole week saved!
       Referral to Cancer Centre
• Elimination of batching in combination with
  reduced turnaround times has resulted in
  earlier referral and therefore earlier treatment
• Knock-on effect all the way to the regional
  MDM
  Referral to the Cancer Centre
‘Being notified of new diagnoses one at a time rather
than in batches is more manageable for secretarial
staff and clinicians. It enables us to process the
paperwork in an orderly manner rather than having
to rush around. Sending information via Cancer
Services is also easier one at a time to prevent
overload.’ GynaeOncology Team Coordinator
       Unexpected malignancies
• Up to 10 cases per year
• Previously could sit in ‘routine’ pile for weeks
  as cases were prioritised and reported
  according to clinical demand/urgency
• Now reported promptly (first-in-first-out)
  Resource wasted chasing results
• Phone calls to histopathology for results
  – 94 in May 09 (10% from clinic)
  – 11 in Aug 10
• Regular lists from Colposcopy, Dermatology
  and MDT coordinators of target/urgent/about
  to breach pts (20 pts/week) – now abolished
  Resource wasted chasing results
• Considerable resource in pathology was used
  to deal with requests for results and
  prioritisation of cases (6hrs/wk)
• How much time was spent outside pathology
  chasing results and dealing with patient
  enquiries??
• ‘if a result is not ready, many patients
  think the worst’
• Used to spend 2 hrs/week chasing results
• Kept patients’ notes on her desk and kept
  checking if their results were ready
• Clinics would often run late and patients would
  be waiting whilst she was phoning for results
• Often rebooked patients or scheduled them for a
  telephone clinic if the results were not available
• Senior Nurse Practitioner, Dermatology
‘I hardly ever have to ring up to pathology for
 results and the nurses’ telephone clinics are a
 doddle because results are always there. Our
 secretaries get less hassle on the phone from
 worried patients.’
Consultant Dermatologist
• A more patient-focussed service with a
  reduction in the patient journey especially if a
  malignancy has been found
• Fewer problems with breach dates
• Fewer phone calls from patients about their
  results
• Confidently giving patients appointments at 2
  weekly intervals if needed.
  Consultant Gynaecologist
‘I used to ask my secretary to print off my clinic list the
week before and I would check if there were any
pathology results that I would need. I used to send a
fax to ask for them to be done...to avoid any
embarrassments and rebookings. I stopped doing this
when your turnaround times improved. I still asked my
secretary to keep the notes of anyone with outstanding
histology results in my office. These piles of notes have
been gradually decreasing in size...today is the first
time ever my shelf for notes with outstanding histology
reports is empty’
Consultant Gastroenterologist
‘This will ultimately provide a
 much improved, faster and safer
 service for patients’
 Chair of the Patients’ Panel

								
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