RSS 1.0Quality Improvement
Recent Submissions
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QI 1279 Reducing Waits for Review in Children’s Speech and Language Therapy MainstreamAim: 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).
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QI 1189 Delivering Family Intervention (FI) Across Early Intervention in Psychosis ServiceAim: To increase the number of families being offered family intervention (FI) by 30% and to increase the number of families receiving FI by 30% across the Early Intervention Service. Family Intervention (FI) is an intervention that NICE state should be offered to all families on the Early Intervention (EI) caseload. CWPT’s offer of FI is BFT. The National Clinical Audit of Psychosis (NCAP) measures how well each service delivers this, historically we have scored poorly in comparison to other Trusts. We have previously trained staff in BFT, expected them to deliver this as part of their role, offered ad hoc supervision, put BFT leads into teams, and told staff they needed to provide BFT. These approaches did not improve our score. Using the learning from the North Warwickshire QI project which improved the uptake of BFT, a different approach has been tried. There is now a dedicated FI team and Clinical Lead. They have used QI methodology to understand where the barriers are for delivering BFT, used this information to create different approaches to deliver, worked with staff to challenge professional bias and change to the culture around FI and carers support. Numbers of families being offered BFT has increased across all the service but the number of families receiving BFT has not significantly increased. When it is being declined it is the families making an informed choice rather than staff making the decision on their behalf. The feedback is that BFT is being offered too early (within 12 weeks) therefore this is now being offered again later.
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QI 1214 Improving Staff Confidence and Competence in Delivering End of Life Care on Acute Dementia Wards (Stanley and Pembleton)Aim: Improve staff's confidence and abilities to care for patients on end-of-life (EOL) pathways. This project ran across Stanley and Pembleton the acute dementia wards. During reflective meetings, staff identified a need around improving confidence in working with people at end of life (EOL). Staff voiced wanting to feel they had done the right thing, despite not being a specialist EOL ward. Staff’s views regarding what they needed to help improve their confidence in working with people at end of life were used to develop training, information and support around the following topics: -Increasing Knowledge and Skills around EOL -MDT Working and a ‘joined up approach’. Providing an appropriate environment and tools to guide interventions (i.e. SOP, pain identification). Tools Used: Staff discussions and feedback. Questionnaires with quantitative and qualitative responses. QI Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Staff report feeling more confident in their abilities to care for patients at end of life (EOL). Service level agreement in place: Mary Ann Evans hospice to offer rapid response to support ward with EOL concerns. Staff report feeling better able to access support from services during/following identifying a patient as approaching EOL. Importance of the need for a SOP identified and development has begun.
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QI 1209 Accurately Reporting on Capacity, Demand and Waiting Times for the Dysphagia Service within Adult Speech & LanguageAim: To accurately report on the Waiting List in order to see a reduction in Actual Waiting Time data from 54 days in December 2022 to a target of 30 days by 30 June 2023 All referrals are received and triaged at ISPA. The service were cold calling patients from the waiting list and triaging the patient and then, if appropriate, booking a face to face appointment. The report was not counting the triage cold call as their first appointment, which showed the waiting times as 50 days for patients to be seen. The service planned to identify the triage calls as New Patient Telephone Slots where the first contact is made with the patient. Admin are able to book these appointments in advance, removing the cold calling and it was hoped that the service would be able to accurately record the data and by doing so would show a reduction in waiting time data. Tools Used: 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; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf. Project Impact: • Waiting time data for the First Patient Contact have decreased from 54 to 30 days (a 24 day reduction) since December 2022. • Decrease in "unable to contact" telephone consultations from 40% in January 2023 to 19% in May 2023. • A more streamlined process for first appointments has been implemented. This has been simplified from 21 steps to 12 steps.
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QI 1221 Reducing Urgent Community Response (UCR) Service RejectionsAim: To achieve a 25% reduction in senior clinical reviews from an average of 52 per month in Q1 2023 to a target of 39 in Q3 2023. A clinical audit was undertaken in December 2022 by the Advanced Consultant Clinical Practitioner in the UCR service; SQ1132 Urgent and Emergency Care Clinical Audit Toolkit. The audit highlighted significant discrepancies in the use of the UCR follow-up clinical review process, which allows UCR clinicians to keep patients on the acute medical caseload for up to 72 hours. Consequently, an improvement project was proposed to reduce the burden of clinical reviews with the UCR senior clinicians’ cohort. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagrams - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Project Impact: The average number of senior clinical reviews decreased from 52 in quarter 1 to 26 in quarter 3. A reduction of 50%. 780 minutes of senior clinician patient facing time were freed up each month - 156 hours per year. Cost savings of £290.68 per month and £3488.16 per year.
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QI 104 Implementation of MOSAIC (Multi-disciplinary One Stop Assessment and Intervention Clinic) within a Home Treatment TeamAim: To reduce the: 1.Proportion of people referred to the Home Treatment Team (HTT) following their initial assessment with the Mental Health Access Hub (MHAH) by 10% 2.Length of stay (LoS) for those patients referred to the Home Treatment Team (90% referrals <42 day length of stay) 3.Waiting time for an initial medical review following referral to the Home Treatment Team by 50%. The initial assessment of patients referred to the HTT should include multi-disciplinary team (MDT) assessment of needs, but involving different professionals often occurs over days to weeks. MOSAIC was introduced as a one stop MDT clinic set up to review newly referred patients who required an urgent assessment. Prior to MOSAIC patients were seen by the MHAH where there was no immediate access to an MDT. The assessment was undertaken by one clinician who determined if the patient required the HTT or another community team. This could lead to delays in the assessment process. Tools Used: Clinical Audit; SPC Charts; Patient/Survey Feedback. Aim Target Achieved Reduce number patients referred to HTT 10% 34% Reduction in LoS (to <42 days) 90% 86% Reduce time to initial medical review 50% 95% Project Impact: Aim - Reduce number of patients referred to HTT - Target 10% - Achieved 34%; Aim - Reduction in LoS (to <42 days) - Target 90% - Achieved 86%; Aim - Reduce time to initial medical review - Target 50% - Achieved 95%.
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QI 1259 Improving Awareness Documentation and Care of Bowel Movements in Learning Disability and Autism (Inpatients, Respite and Community)Aim: To identify constipation at an early stage or any changes to bowel habits that could indicate a physical health condition. To empower patients and staff alike to have healthy and open conversations regarding their bowel movement and urine output health and when to act upon it. Historically, conversation and awareness of healthy bowel movements (BM) has been a taboo topic amongst both staff and patients in Learning Disabilities. Patients in particular can find the topic uncomfortable to talk about which can lead to gaps in healthcare; making it harder for staff and patients to understand their physical healthcare needs. Constipation is also a contributor to death with those of a learning disability (LeDeR reports), with a high use of laxatives for LD&A patients. Initially, a project was proposed to look at physical healthcare as a whole, however it was quickly understood that the topic was extremely broad and a few different projects were initiated, including this one. Tools Used: Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf Project Impact: • A Physical Health Group and Patient Forum has been started in LD&A to foster open conversations. • Patients have been taught to self-report with a user-friendly chart. • Vinyl stickers are now in all toilets to help patients identify good vs bad bowel movements. • Standardised chart to help staff monitor bowel movements in a standard way. • Staff and patients feel more empowered to talk about bowel movements. Staff Feedback; “We have a patient on the ward who is very independent and doesn’t talk about bowel movements. We used the self-reporting chart and they thought it was great! They wrote down their BM and were happy to show us the chart. They said they don’t like to talk about it, which is why they’d never told us before.”
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QI 110 To Improve Access for Families to Family Intervention in the North Warwickshire Early Intervention Team (EIT)Aim: To increase the number of families offered family interventions (FI) in North Warwickshire EIT by 10% by September 2022. FI should be offered to all families who receive an EIT service. Data from the 2020/21 National Clinical Audit of Psychosis (NCAP) showed we were underperforming (14%) and were identified as an outlier for this audit standard. Quality improvement methodology was used to scope the available data to understand the current process by mapping referrals and the last 10 patients. A driver diagram was developed to identify change ideas which could be implemented within the North Warwickshire EIT service. Using Plan, Do, Study, Act (PDSA) cycles we were able to see whether the change had been effective. The statistical process control (SPC) chart (left) illustrates the number of people being offered FI and whether the change has been sustainable. 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 project aim has been exceeded-Number of families being offered FI has increased by a mean of 262% . Other identified benefits: •Clearer pathways in place for clinicians to identify families. •Stepped care approach embedded into EIT practice. •Robust supervision in place. •New Family Intervention Team being appointed.
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QI 111 Improving the Equipment Ordering Process in Children's Therapy ServicesAim: 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.
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QI 117 Improving Physical Health Care Provided by Coventry 11-17 (Psychosis Pathway) TeamAim: By 9 July 2022 for patients open to medical staff only in the Coventry Recovery Team (N=96): 1. 30% will have been offered an appointment to complete the lifestyle screening tool. 2. 20% will have had a physical health and lifestyle screening tool completed. The trust requires that all patients open to the service with psychotic disorders have an annual physical health screening assessment. Prior to this project there was a nurse and health care led process in place which was unable to meet these requirements. Baseline data showed that of those patients only open to the medical team 13.5% had been offered a physical health screen and only 12.5% had a completed assessment over the past 3 years. Tools Used: PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf; Project Impact: Completed physical health assessments increased from baseline by 20% up to 32.5% at week 16. Cycle 2: aimed at non-attendance. Providing generic information improved this by 3.6% but a personalised letter to non-attenders at a 1st appointment (n=3) resulted in them all attending a 2nd appointment.
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QI 1195 Improving Flow of Care Needs Through Urgent Community Response (UCR)Aim: Improve patient flow from UCR Care into Adult Social Care (ASC) and staff to generate referrals to ASC within 3 to 5 days of assessment by October 2023. UCR (Urgent Community Response) is a dedicated crisis response team of Advanced Clinical Practitioners, Nurses, Therapists, Advanced Practitioners, Health Care Assistants and Admin who work with patients to prevent unnecessary admission to hospital by providing a rapid intervention delivered within two hours. The team wanted to use QI tools to improve their service. They wanted to meet their target of 3-5 days for referral to adult social care and they wanted to reduce over-prescription of care. Average length of stay at the start of the project was 6 weeks+; the team aimed to reduce this to 7 days. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf; Mapping the Last 10 Patients - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-last-10-patients.pdf. Project Impact: • Average LOS for UCR Care reduced from 6 weeks in July 2022 to 2 weeks in October 2023. • The average time taken to refer to ASC was within the 3-5 day target by June 2023.
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QI 102 Implementing a Telephone Triage System in Integrated Sexual Health Service (ISHS)Aim: To reduce in-clinic waiting times for patients attending the open access clinic by 50% by 31st January 2020. Prior to the Covid-19 pandemic a face-to-face triage system was in place. Being a walk-in service, patients were required to queue before entering the department. If clinic capacity was reached, they would have to be turned away. There were frequently long in-clinic wait times (on an average 73 minutes) before first contact with the clinician could occur. In response to the pandemic, a telephone triage system was implemented. The aim of this was to reduce the in-clinic waiting time and provide a safe and effective system during the pandemic. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: 70% of patients said that they had to wait for less time than the previous attendance. •83% of patients felt comfortable sharing information over the telephone. •100% of patients were satisfied with the outcome of the triage. •87% of patients were satisfied with the service offered. •Overall staff preferred the new telephone triage system. The waiting room is quieter and there is less pressure on the reception team.
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QI 120 Improving Attendance in the CPIP (Cerebral Palsy Integrated Pathway) ClinicAim: To reduce the mean DNA (Did Not Attend) / WNB (Was Not Brought) rate at the CPIP Clinic from 26.8% to 10% by July 2022. The CPIP clinic experiences several missed appointments each week. These unused clinic slots are very costly due to multidisciplinary staff involvement. QI tools were used to monitor non-attendance, review processes and develop change ideas. PDSA cycles were used to test change ideas including the introduction of automated text messages and the streamlining of admin processes. 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 - www.england.nhs.uk/statistical-process-control-tool/; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Project Impact: The team reduced the DNA/WNB rate from 26.8% to 10.6% and implemented a cancellation process. They now have benchmarking data to assist them with the next steps of the project. An unintended consequence of the project was an increase in the cancellation rate from 6.7% to 17.6%. This has led to a continuation of the project with a new project aim: To improve the mean attendance rate in the CPIP clinic from 71% to 90% by July 2023.
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QI 149 Increasing Referrals to the Children’s Cerebral Palsy Strengthening GroupAim: Increase the referral rate for the Cerebral Palsy strengthening group from 0% in March 2022 to 80% by September 2023. A virtual group was set up in 2021 for children and young people with Cerebral Palsy. As Covid restrictions reduced there was a noted decrease in referrals and an increase in requests from parents to move the group from virtual to face to face. The project was initially set up in March 2022 to scope the barriers to referral and attendance and improve the referral rate into the group. Increasing referrals would mean that sufficient outcome measures could be collected to evaluate clinical effectiveness of treatment. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf. Project Impact: The referral rate increased to 81% of the full capacity for the group. Seeing patients in a group rather than 1:1 has: Saved 18 hours of staff time per cohort (108 hours of clinical time saved over the last year). £373.74 has been saved per cohort. This equates to savings of £2242 over the last year and up to £2616 next year. Attendance at the groups has enabled us to collect and compare data through outcome measures. These have shown large clinical benefits which have been maintained when 1 year post group outcome measures have been repeated. Average improvement in 6 minute walk test (6MWT) scores for GMFCS 1 and 2 patients show a statistically significant improvement. The group has progressed to running face to face and since re-starting in January 2023 has successfully run with patients within each group and referral rates above 50% maintained in each cohort. All patient feedback has been positive. The average improvement in strength (MRC) showed increase or maintenance in all areas for each patient.
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QI 148 Improving Patient Flow across Urgent and Reablement TherapyAim: 90% of Reablement patients to be seen with in 48 hours of receiving the referral (Monday – Friday) 100% Urgent Community Response (UCR) Therapy patients to be seen with in 48 hours of receiving the referral (Monday-Sunday). Following the publication of Urgent Community Response (UCR) guidance by NHSE in July 2021 CWPT has responded with the development of their own UCR team. This in turn was predicted to change the utilisation of therapy within the urgent offer. Patients need to be seen within the timescale specified by triage which can be 4-6 hours / 24 hours / 48 hours. The therapy team that responds to the urgent referrals also provides the on-going up to 6 weeks Reablement service. Any changes to the urgent response roster will have a knock-on effect on the reablement offer. Therefore, we needed to explore how to maximise capacity to fulfil the requirements of both Urgent and Reablement Therapy using QI. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Waiting times for Reablement patients January 2022 = 3 weeks. Patient facing activity time during every working shift varied across the team from 42% to 99% against a target of 67%. Developed a way of measuring waiting times for UCR patients. Next Steps: Daily monitoring of: Waiting list /Capacity and demand / Patient flow. Scoping what capacity can be released from both clinical / non clinical perspective to support service improvements and patient flow, followed by, scoping funding for Patient Flow Coordinator to release further clinical capacity. Preparing for AHP job planning. Equitable workload across the services. Plan for future workload for the service e.g., trajectory of wait lists being cleared.
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QI 152 To Improve Patient Safety for Those at Risk of Choking in an Inpatient SettingAim: To Increase Awareness and Increase Referrals by 30% for Patients at Risk Of Choking Within Learning Disabilities & Autism & Mental Health Inpatient Services. This project has been run jointly across MH and LD&A inpatient services. Across the services there were only small numbers of referrals being received, these were often following very severe choking events. Previous attempts to implement a referral process had been been unsuccessful. The processes, referral information, national guidance etc were reviewed to understand the current situation. Based on this a screening tool and referral process along with awareness training were developed and tested on one ward and gradually rolled out across other wards as the tool and process was adapted. Awareness training has been rolled out across the mental health wards and as part of staff induction in Learning Disabilities and Autism. Tools Used: Driver Diagrams - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: Standardised screening tool for assessing risk and making referrals to Dysphagia Service. Monthly report to Dysphagia Service re: choking incidents. Increase in referral rate for dysphagia assessment. Increased staff awareness across inpatient services. Screening being embedded into MH & LD&A admission pathway. Screening being completed as standard within Health Action Plan in LD&A. Facilities awareness and food Modification training.
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QI 172 Improve Time Taken From Referral to Assessment in Children's Dysphagia ServiceAim: 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.
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QI 114 Providing Immediate Staff Support Following a Difficult IncidentAim: Reduce the percentage of staff who felt not supported at all following a difficult incident from 21% to 10% by October 2023. Within the specialist assessment and treatment learning disability inpatient services at Brooklands, staff are subject to and witness to high levels of physical violence towards others, towards the environment and self-injurious behaviour. The team wanted to ensure that staff were receiving the right support at the right time following a difficult incident by developing a robust process for providing immediate support. The team looked at incident data and gathered staff feedback. The team then developed a set of guidance for staff to support them in providing this support and in recognising when and how to signpost colleagues to further support where needed. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Project Charter - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-define-your-project-charter.pdf. Project Impact: The new guidance promotes consistency and provides a structure to the process which was not previously in place. The percentage of staff who felt not supported at all following a difficult incident reduced from 21% to 15%. Staff feel 26% more confident to provide support following an incident. Improvements are being made to staff well-being through feeling supported and valued. The percentage of staff who felt a bit supported or very supported following an incident increased by 5%. Awareness of additional support (TRiM) has increased by 31%. The improvements link with Trust policy and align with the Trust drive to be trauma-informed. The improvements contribute to a culture of openness.
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QI 1263 Improving the Delirium Pathway at an Acute Hospital: GEH AMHATAim: Reduce the percentage of referrals to AMHAT for delirium from 35% to <10% by 31st December 2023. AMHAT at CWPT provides liaison work to UHCW, SWFT and GEH and receives referrals from each of these areas. Delirium is a medical condition which needs to be treated medically by professionals at acute hospitals. Patients with delirium should not be referred to AMHAT. It was noted by the GEH AMHAT team that a relatively large number of referrals from GEH wards had delirium as an outcome. These inappropriate referrals delayed patient management as patients were waiting for a review by AMHAT when they could have received medical care on the ward. These cases also utilised AMHAT time that could have been directed to prioritise more appropriate referrals and tasks. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf. Project Impact: There was a reduction in the number of referrals identified as delirium from 44 (35%) in June, July and August to only 8 (6%) in October, November and December. Each inappropriate referral would take an AMHAT clinician an average of 1 hour, this equates to a potential saving of 36 hours of clinical time over October, November and December which could be utilised to reduce waiting times for other patients. Patients receiving the appropriate care on the ward rather than waiting for AMHAT review means their length of stay is reduced - a potential reduction of 72 bed days. Early management of patients as per the Delirium Pathway has increased leading to better patient experience. Right care at the right time and earlier discharges. Better prioritisation and use of clinician time for both Acute hospital staff and AMHAT.
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QI 1281 Improving Documentation of Patient Referrals into Community PaediatricsAim: By the end of April 2024, 100% of new patient referrals into Community Paediatrics (CHWB) will be processed via Carenotes and, if accepted, added to a new patient waiting list. Historically, all new referrals are saved down as files to the Y : Drive under ‘Awaiting Triage’, then (once accepted) as ‘Awaiting 1st Appointment’. Not only does this system not make use of the implemented Trust Care Records system, it makes the team vulnerable to data loss or misfiling. The service is also unable to pull meaningful reports to reliably know referral numbers. Tools Used: Project Charter - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-define-your-project-charter.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Model - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf; Brainstorming - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-brainstorming.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf; Stakeholder Feedback; Ohno's Eight Wastes - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-lean-ohnos-eight-wastes.pdf. Project Impact: • 100% of new patient referrals are now categorised and processed via Carenotes. • A 26% increase in the overall sustainability score for the project compared to pre and post, with ‘Organisation’ seeing the biggest improvement of 80%.
