Aim: To reduce length of wait for follow up review assessment within school age caseload (mainstream schools, non-EHCP service) by 30%. This project was carried out to address the waiting time for follow up (review) assessment in the Mainstream schools (non-EHCP) caseload in Children’s SLT. The project started in June 2023 when the wait for a follow up assessment was beginning to increase, the longest wait being 28 weeks. 1.5 days per week clinical time was taken up by band 6 SLTs managing 6 separate Mainstream caseloads (11hrs per week). A number of change ideas were tested and implemented to streamline the caseload and caseload management system, introduce an opt in system for parent/carers, consider the use of diary sheets for admin staff to book directly into, and considering how both SLTs and SLTAs worked within the sessions. These changes overall helped maintain and then reduce the wait time for a follow up assessment. It is important to note that other changes within the service (external to this project) have also had a positive influence on the wait times and overall size of the caseload, these included the introduction of a language package of care (throughput model) and an unusually low opt in rate over summer 2024. Monitoring of the data has allowed for the impact of these changes to be observed. Having one overall shared database for the entire Children’s SLT caseload helped with data collection and oversight of the caseload. Tools Used: Process Map - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf; Understanding the problem; Stakeholder Engagement - www.aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Measurement - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-measurement-for-improvement-overview.pdf. Project Impact: A more consistent and standardised approach in dealing with queries from schools and parents. Reduction in unnecessary appointments for children who don’t require one. Aligns the process with the rest of the service. Caseload size has reduced and then remained fairly static (even over the month of September when there is usually a large influx of preschool transfers).

Aim: To understand the length of time from assessment to handover of equipment for orders placed by the Children’s Community Physiotherapy and Occupational Therapy Service between 06/02/2019 and 13/03/2020. The Children's Community and Physiotherapy and OT Service perceived that children were experiencing significant waits for their equipment. They used a SPC chart to look at how long children were waiting from their assessment to the handover of their equipment and to identify where improvements could be made. Changes to local ordering processes were made and PDSA cycles were used to monitor and develop the change ideas. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf. Project Impact: The team gained an understanding of their equipment ordering processes and introduced a streamlined process which reduced the time children spent waiting for equipment from an average of 207 days prior to November 2019 to 60 days from November 2019 onwards. A 71% reduction in waiting times.

Aim: To streamline the processes in Children’s Dysphagia initial assessment. This project was carried out to maximize reduced capacity, whilst maintaining the 10 day KPI for initial assessments. A variety of tools were used to understand where the issues were. During process mapping it became clear that there were two areas of focus, Triage and Attend Anywhere (AA). All families were contacted by telephone for a triage appointment by the speech and language therapist (target of within 10 working days) and were then all booked into a face to face or AA assessment. As they were all booked into an assessment appointment at a later date, following triage, this was causing a delay for assessment. A large number of AA appointments were needing to be rebooked due to failed assessments and were then being rebooked into another initial assessment rather than a follow up slot. The team all agreed that this client group was difficult to assess via AA. Triage has been taken out of the process and the patient flow team are now booking all new referrals in with a speech and language therapist for their initial appointment, face to face, within a target of 10 working days. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf; SPC Chart - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: On average the number of children seen within 10 days of referral has increased from 17% to 57%. Six steps have been removed from the process and bookings for assessment have been moved to an admin function.

Aim: To evaluate the effectiveness of introducing Neonatal therapeutic input and collaborative working in George Eliot Hospital (GEH). The ‘Theory of Moral Injury’ (led by Čartolovni et al) was established during the pandemic following observations around inflicting human suffering during life saving treatment. This research is increasingly being applied to Neonatal care, acknowledging the pain caused to save tiny babies lives, the quality of life that child may be left with and effect of the families long term. A new role was created in the Special Care Baby Unit (SCBU), where there was previously no therapeutic input for neonatal patients. Gorge Eliot Hospital (GEH), recognised and funded the role, with the scope of the full service open to improvement. Tools Used: PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Fishbone Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-cause-and-effect-fishbone.pdf; PESTL Framework. Project Impact: A reduction from 100% to 0% of Neonatal babies needing major repositioning following Neonatal therapy input.

Aim: To reduce the waiting time for splints for young people in Coventry from a maximum of 174 days to a maximum of 7 days by June 2022. Children and young people were assessed once a year in the Hand Splinting Clinic and were issued with prefabricated splints. Delays of up to 174 days were caused if the required splints were not in stock due to splints being ordered from overseas. The cost of these splints and staffing was around £105.00 per splint. The delays resulted in some splints not fitting the children by the time they had arrived due to growth, leading to excess stock and reordering. This improvement project aimed to reduce waiting times and costs. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Project Impact: We achieved a reduction in waiting times from up to 174 days to 0 days leading to better patient experience. The average cost of fitting a splint reduced from £105 to £80. Fabricated splints cost less. We saved approximately £6000 over the last financial year.