Chelsea and Westminster Hospital NHS Foundation Trust

Project aim: To access the patient voice in 80% of patients accessing epilepsy services at Chelsea & Westminster and West Middlesex Hospitals, between January and March 2020, to influence improvements (which improvements give examples) in cross-site epilepsy care.

Project aim

To access the patient voice in 80% of patients accessing epilepsy services at Chelsea & Westminster and West Middlesex Hospitals, between January and March 2020, to influence improvements (which improvements give examples) in cross-site epilepsy care.

Tests, changes and what was learned in the process

December 2019

  • Cycle 1: Each team member to discuss potential feedback capture methods with 3 patients e.g. paper based, verbal, phone app and/or pasta voting to establish preferences.
  • Cycle 2: Each member to consider their priorities for potential questions.
  • Cycle 3: To make contact with Emma from RCPCH &US team regarding survey design.
  • Cycle 4: Set up a team WhatsApp group and have a face to face meeting within 2 weeks.

January 2020

The questionnaire has been finalized and is now in use. Plan to give the questionnaire to all follow up patients attending secondary level epilepsy clinics, ANP clinics, tertiary neurology clinics and attending for EEG.

February 2020

We have been aiming to give out the questionnaire to follow up patients attending secondary care, tertiary epilepsy clinics and EEG. The aim was to evaluate the data of returned questionnaire vs handed out and to figure out the most successful way to achieve a high return rate.

Results

December 2019

  • Patients expressed preference for a short paper based questionnaire.
  • We are in touch with Epilepsy Action regarding the questionnaire.
  • Team members have been brainstorming questions. Spread of issues affecting various areas of service broadly established and we are working on prioritising these to write questions.

January 2020

We had aimed to begin distributing the questionnaire from the beginning of January.  However, time constraints and leave over Christmas made meeting with the team to finalise the questionnaire impossible and the questionnaire was ready from mid-January.

February 2020

There were several challenges handing the questionnaire out by reception staff. We therefore agreed to hand it to patients during clinic appointment. There is usually time to complete questionnaire at the end of the consultation while clinician completes administrative tasks.

Challenges and retesting

December 2019

  • Impossible to arrange a face to face meeting due to cross site working, but we have had a conference call with all but one team member to discuss the project and survey design / questions. Difficult to keep all team members up to date of progress without bombarding with messages – challenges in avoiding duplication of work.
  • Due to our differing roles and different pressures and concerns in the various areas of the service, the priorities of where to focus questions have been different for the team members. Very difficult to design a questionnaire with questions relevant to secondary and tertiary services and neurophysiology.
  • Challenges in keeping the questionnaire short with meaningful questions and measurable responses.

January 2020

  • The outpatients’ department is extremely busy with up to 18 clinics running simultaneously and clinics often run late. Because they are so busy, reception staff do not always remember to hand out the questionnaires.
  • During the first week in use, the secondary level clinics were running late and doctors forgot to hand out the questionnaires.
  • There are currently no neurophysiology technicians to perform EEGs at the Chelsea site. The service is being run on an ad hoc basis with bank technicians until posts are filled. Therefore, it’s currently not possible to engage the EEG service with the questionnaire use.

February 2020

The clinics are usually overrun and overbooked. We as clinicians have often forgotten to hand out the questionnaire or the questions asked were not relevant as patients are also under private neurologists.

Next steps

  • Continue giving the questionnaire to all follow up patients attending secondary and tertiary level epilepsy clinics and ANP clinics.
  • Capture the data on how many questionnaires are handed out vs how many are returned and to try to capture the data on when the questionnaires are handed out (i.e. before clinic by reception staff or during clinic by clinicians) to determine the most successful way to get a good response rate.
  • Perhaps test other methods as the questionnaire might not be the best tool for these areas.
  • Those children currently missed when attending for EEG may be captured when they attend epilepsy clinic. The paediatricians agreed to try to capture those children missed due to forgetting the questionnaire or didn’t fill it in completely, by telephoning the families to ask if they would participate, and then posting the questionnaire with a stamped addressed envelope for return.

Team presentation

Chelsea and Westminster Hospitals’ team presentation at the EQIP celebration event describing their journey in accessing the patient voice to influence improvements in cross-site epilepsy care for patients and families that attend their service at West Middlesex Hospital:


Would you like to know more about these projects? If you would like to contact any of these teams about their QI work then please get in touch with the EQIP faculty at eqip@rcpch.ac.uk

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