Guy’s and St Thomas’ NHS Foundation Trust

Project Aim: To obtain feedback from 50% of patient/families seen in tertiary Epilepsy Clinic in January and February 2020 regarding their perceived appropriateness of the time interval between follow up appointments. This will allow us to identify any current problems so we can make improvements to our clinic booking service.

Project aim

To obtain feedback from 50% of patient/families seen in tertiary Epilepsy Clinic in January and February 2020 regarding their perceived appropriateness of the time interval between follow up appointments. This will allow us to identify any current problems so we can make improvements to our clinic booking service.

We would do this using a patient survey to obtain feedback from 50% of patient/families seen in Tertiary Epilepsy Clinic at ELCH in February and March 2020 regarding their perceived appropriateness of the time interval between follow up appointments and the service overall.

Tests, changes made and what was learned in the process

December 2019

First tests: Done in Complex Epilepsy Clinic on 18th November.

Draft Survey of 10 questions tested on 2 families and asked for feedback regarding appropriateness of questions.

January 2020

I have met on several occasions with a member of Patient Experience Team to discuss our projects aim and design our pilot patient survey. We also reviewed the draft survey in our EQIP team meeting and made amendments. However, no formal testing took place in this period.

February and March 2020

Our pilot epilepsy survey was given out to patients and families that attended follow up appointments for Epilepsy clinics at the Evelina Children’s Hospital. The trial period was a 2-week period: 22nd January until 4th February. The number of surveys completed was 15. These are the aspects that we wanted to address first. This is only a small sample so we needed further data to be collected.

April 2020

Surveys completed over a total 7 week period, offered at face to face Epilepsy clinic appointments at ELCH. Dates: Pilot 22nd January until 4th February (n=15), 10th February until 15th March (n=31). Total Number of surveys completed was 46.

Challenges and retesting

February 2020

100% response rate for the surveys given out but it was not offered to all follow up patients as clinics were busy and often it was forgotten.

Due to the delays in getting the survey ready, we have amended the data collection period (initially was supposed to be Jan and Feb) but for a 6-week period extending until the 31st March.

March and April 2020

We were unable to offer more surveys in March, as all face to face clinics were converted to telephone clinics due to the impacts of coronavirus.

Results

December 2019

Feedback that questions were straightforward and easy to understand, short and quick to complete, would be happy to complete written or online survey e.g. survey monkey

January 2020

No formal testing took place in this period.

February and March 2020

The data was collected and analysed. Some findings to report so far, they have been generally satisfied with the clinic booking service and that the majority are not getting enough notice before the clinic appointment. (see below). There is also discrepancy on how people are informed e.g. letter, text or phone call etc.

We got 100% response rate for the surveys given out in the trial period but it was not offered to all the possible follow up patients as clinics were busy and often it was forgotten. We discussed strategies to try increase our offer rate of the survey, by mentioning it at the beginning of the consultation so this wasn’t forgotten but this continues to remain a challenge.

We have devised a Process Map of the current clinic booking system to help us look at the pathway:

April 2020

Overall satisfaction with the clinic booking service was good-84% very satisfied or satisfied. Causes of dissatisfaction:

  • Difficulty contacting appointments team to chase and change appointments
  • Not enough notice before clinic appointment (only 52% >3 week-notice before clinic date)
  • 15% had to contact the hospital themselves

Inconsistent ways of informing patients and families of appointment and re-confirming appointments

Perceived appropriateness of the time interval between follow up appointments was reasonable, (80%) but there is room to improve.

It shows patient/parent wishes to have a personal choice when booking date/time of next appointment (58%) and wish to verbally agree and book provisionally next appointment with medical professional in clinic (36%).

Despite our booking pathway (above), the results of survey have been shown to our service managers and we have been informed that there is no official standard operating procedure for this process. Therefore, we will gather as much information about the current process from our clinical booking team members and we will look to implement a new pathway to address the issues identified from the survey.

We will need to have further discussion with managers and administrative staff, so we can decide on and put in place specific interventions. This may be difficult during this time due to the coronavirus situation so there may be a delay.

Next steps

We would first want to look at specific strategies:

  • To aim to give patients and their families more notice before their appointment (> 3 weeks)
  • To standardise the methods of how appointments are confirmed and how the patients and families are informed

We would look to repeat the use of the epilepsy survey in the future to look for perceived improvement of the clinic booking service following these changes (we can use a shortened version targeted to assess the specific interventions implemented).


Team presentation

Guy’s and St Thomas’ NHS Foundation Trust’s team presentation at the EQIP celebratory event describing their journey and improvement project based on obtaining feedback from patient/families in tertiary epilepsy clinic:

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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