North Tees and Hartlepool NHS Foundation Trust

To reduce waiting times of seeing new seizure referrals from 16 weeks to 4 weeks in 50% of referrals by the end of March 2022

North Tees & Hartlepool Trust

Project aim

To reduce waiting times of seeing new seizure referrals from 16 weeks to 4 weeks in 50% of referrals by the end of March 2022.

Background

The North Tees and Hartlepool NHS Trust are based in two sites, and provides service to around 400,000 people. The trust caters for children and young people of about 90,000 to 95,000.

Our Epilepsy team consists of 3 Consultant with special interest in Epilepsy and 2 Specialist epilepsy nurses.

The report on Epilepsy 12 audit from Cohort 2 identified that we are doing really well in many areas, however in some areas we are outliers:

  • The North Tees & Hartlepool NHS are outliers In the timings for seeing first seizure referrals. 31% are seen after 16 weeks when the National average is less than half.
  • It is identified that we work on improving access in the next 6 months hoping to bring the referrals waiting time in line with NICE guidance.  Currently we are 16 weeks as per the epilepsy audit and ideally it needs to be within 2 weeks.  Our aim is that at least 50 % of new patients referrals should be seen within 4 weeks within the next 6 months and hopefully, by a year we hope to be compliant with the NICE guidance. 
  • Majority of referrals are coming from the GP and Outpatient dept. (which is different to other units in the country and needs to be looked at In detail). (NICE recommendation is to see in 2 weeks).

Tests, changes and what was learned in the process

August 2021

The initial project aim in terms of Quality improvement has been to improve the period of seeing patients following referral to our Epilepsy service and bring in line with NICE recommendation of 2 weeks. 

September 2021

At subsequent meetings driver diagrams with aims were made and specific issues were identified and action plans drawn up.  

With subsequent meeting with EQIP, we learnt that that an important aspect of any improvement plan is to identify how we can improve that patient participation and engagement and incorporate  patient views on how to achieve to this in any improvement projects. 

October 2021

Subsequent to EQIP meeting we had meetings with our epilepsy team members and also had meeting with booking office teams. We identified several problems regarding our referrals systems and worked on several action plans:

  1. As an initial step, we decided we should have standardised templates for clinics so as to have uniformity.  

We identified that some of us were having variable new and review patient template. There was no clear information on Royal college sites or Best practice tariff pages regarding an epilepsy clinic template and how long is needed as a time frame for new patient clinic appointment time and similarly for the reviews. We looked at neighbouring Trust’s Epilepsy clinic templates. Each had different types of templates, some had 1 hour for new patient and some had 30 minutes for new patients.

We discussed and standardised our template with 3 new patient slots (45 minute each) and 5 review slots with 20 minute slots (total clinic time is 4 hours). This is now in place and is functional. 

  1. 2. We identified that our new patient slots were often booked with review patients, which meant that new patient appointment are given several weeks down the line. 

Action: We have made arrangements with Booking office to leave a single NP slot per Epilepsy clinic for up to 48 hours so that any urgent referrals can be booked into the clinics at short notice. If no new patients are booked and less than 48 hours, booking office to book review patients into this slot. This has been agreed and we have to see whether this is working. This means that between the three consultants there would be a maximum of 3 NP slots free for booking of referrals. 

  1. 3. We have created pathways for referral to Epilepsy clinics for any patients admitted to ward from A&E with afebrile seizures.

The referrals would be processed by booking office and would be booked into next available New patient slot. This is now functional 

  1. 4.We identified that many referrals were addressed to named Consultants. Some of them were getting a lot more referrals than others get (They were in posts a lot longer and many GP’s know them).

This meant that their clinics had no new patient slots for several weeks as it is full with referrals and waiting times were 12-16 weeks. Whereas other Consultants had slots in 3-4 weeks. The action taken was to have an arrangement with the booking office to book these patients to next available slots. The Booking office informed us that they couldn’t do that unless we clearly write in the Vetting outcome (when we vet the referrals) as to ‘give appointment in any of the next available NP slots with any consultants’. This is now being implemented. 

November 2021 

  • We had a general consensus during our team discussion in the first EQIP meeting that we needed to work on epilepsy referrals and improve access to patients to the service and there by improve their experience.   

Our aim is that at least 50 % of new patients referrals should be seen within 4 weeks within the next 6 months and hopefully, by a year we hope to be compliant with the NICE guidance. 

Progress on Project aim (Nov-Dec):

  • After we joined the QI project, we recognised that this is not achievable within the QI EQIP period and so in our driver diagram we reported our objective as to reduce this period to 4 weeks in 50% of referrals.
  • We recognised that for long-term success the importance of having a collaborative approach with incorporation of patient/parent’s viewpoints and their experience and including them for improving patient engagement.
  • We had made several changes to our referral systems as explained in the previous report, which we hoped, would streamline and improve referral periods.
  • Last few days we were involved in doing a brief audit on whether the changes we made have had an impact in reducing the delay in seeing patients
  • We also selected four patients and spoke to them regarding their experience in terms of any delay in seeing or whether we have seen them timely and any feedback on their experience any improvement required to improve their experience. 

December 2021

After we joined the QI project, we recognised that the initial aim of improving the period of seeing patients following referral to our Epilepsy service and bringing  ‘in line with NICE recommendation of 2 weeks’ is not achievable within the QI EQIP period and so in our driver diagram, we reported our objective as to reduce this period to 4 weeks in 50% of referrals. 

We recognised that for long-term success the importance of having a collaborative approach with incorporation of patient/parent’s viewpoints and their experience and including them for improving patient engagement.  

We had made several changes to our referral systems as explained in the previous report, which we hoped, would streamline and improve referral periods. 

Last few days we were involved in doing a brief audit on whether the changes we made have had an impact in reducing the delay in seeing patients 

We also selected four patients and spoke to them regarding their experience in terms of any delay in seeing or whether we have seen them timely and any feedback on their experience any improvement required to improve their experience. 

Results

November 2021

Regarding incorporation patient experience, we planned to undertake a patient survey. The questionnaire has been prepared and submitted to the IG team. We are awaiting clearance from the Information Governance team. 

  • In the interim, we also looked at a patient experience and journey in one patient whom we had seen within 4 weeks’ period of being referred to the Epilepsy clinic.   
  • Patient A- referred to general paeds by GP and seen on 21/07/21 
  • EEG done 25/08/21 
  • EEG report and   received on 03/09/21 and discussed with epilepsy nurses 

Referral to Epilepsy consultant (Discussed EEG report with consultant paediatrician with expertise in epilepsy) on 14/09/21 and appointment offered for 23/09/21 as “extra patient” as no new patient appointments available.

We came up with our service improvement proposal for leaving one new patient appointment free so that we can ensure patients are seen ASAP. The patient was added to new patient appointment from a referral done on 23/10/21. This meant that we did see the patient in 3 weeks; however, it was seen as an extra which is not ideal.  

December 2021

Following the data collection, we attempted to call the ten families to ask about their experience and what their views were on the waiting times. So far, we have only four responses:

  • Patient A (7 weeks)” Quite happy the way it was turned around”.  
  • Patient B (4 weeks) “Experience was really good, wait okay. Consultant was excellent”. 
  • Patient C (4 weeks) “Quite alright as it gave us time to digest what had happened. Any sooner would have been too much information”. 
  • Patient D (4 weeks) “Very impressed at the waiting time, thought it would be much longer. We already have the next appointment too”. 

We hope to include Children’s &  Young people’s views as the above views are all parents’ experience and views. 


Team presentation

 


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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