Nottingham University Hospitals NHS Trust

Project aim: Achieve a full quality and interpretable routine EEG recording in 95% of all paediatric patients referred within 4 weeks from referral by May 2020.

Project aim

Achieve a full quality and interpretable routine EEG recording in 95% of all paediatric patients referred within 4 weeks from referral by May 2020.

Tests, changes and what was learned in the process

December 2019

PDSA 1 – Parents and carers of patients with autism, learning disability receive a phone call the day before they come for an EEG. This allows us to get a ‘heads-up’ and to answer any queries or anxieties from the patient or parent /carer. Also able to signpost the ‘Evelina’ video on coming for an EEG.

PDSA 2 – Patients are given questionnaires after coming for an EEG to gain feedback on their experience.

PDSA 3- Have tentatively taken our breach date down to 4 weeks rather than the current 6 weeks which is in line with NICE guidelines.

January 2020

PDSAs 1-3 ongoing

PDSA 4 – Created a ‘pasta-poll’ to gain feedback direct from patients rather than parents. Have used the question ‘How did we make you feel today?’ Have 2 different coloured Ping-Pong balls to differentiate between routine ‘normal’ patients and those with learning difficulty, ASD etc. Vote to say happy, not sure or sad.

PDSA 5 – Made enquiries as to cost of own departmental video – coming for an EEG

PDSA 6 – Follow-up call to parents if a child has been particularly upset to gain feedback on what we could have done better.

February 2020

All existing PDSAs ongoing.

March 2020

PDSA 7 – Additional leaflet to go in patient leaflet with links to online resources – Evelina video, plus our adult learning disability leaflet and video to help prepare patients coming for the test

April 2020

PDSA 7 – Had just organized everything for PDSA 7 before all out-patient clinics were cancelled.

Challenges and Retesting

December 2019

  • Having resources / time to make the phone calls. Currently only one staff member making the calls and only in 3 or 4 days per week so bit hit-and-miss. Plan to perhaps include questions when patient rings to make their appointment and be conducted by office staff? Although for continuity and patient pathway it would be better for physiologist performing the test to be the one to ring them in the first place?
  • Not a huge number of questionnaires back so far so may do a pasta poll of one questionnaire question every 1-2 weeks in the department before the patient leaves. This may be a step too far and patients may want to leave the department quickly if the EEG has been particularly traumatic!

January 2020

  • Time resourcing issue around phone calls continues.
  • Quote of approx. £1200 for own departmental video – may be a long term goal / project.
  • Physiologists / scientists haven’t / are reluctant to pass on details of difficult patients (in case of harsh feedback?

February 2020

  • Time and resourcing issue around phone calls continues. However, parents and carers that have received phone call prior to the EEG have been very grateful saying ‘what a great idea’, ‘what a great service’.
  • Interdepartmental video is still expensive – plan to perhaps bid for charitable funds.
  • Issue with physiologists/scientists not passing on information continues.

March 2020

  • Still struggling to make the phone calls to patients (mainly due to time) so have started sending out an addendum to our patient leaflet.

April 2020

  • Still struggling to make the phone calls to patients (mainly due to time) so have started sending out an addendum to our patient leaflet (as above in planned tests) – obviously this is on hold.
  • Everything now on hold as we wait to start booking out-patients once more.

Results

December 2019

PDSA 1. Very positive feedback from parents and carers so far. Appreciate the call before they come to discuss needs etc.

PDSA 2. Starting to get questionnaires back with feedback requests for a pre-EEG phone call, visits to the department beforehand and EEG video of what the test involves.

PDSA 3. Too soon to comment on 4-week breach date.

January 2020

Same feedback for PDSAs 1 and 2.

PDSA 3. 4-week breach date going ok at the moment but may have to keep an eye out as reduced capacity for EEGs over Christmas and planned downtime for department floor covering change.

February 2020

Same feedback for PDSA 1.

PDSA 2 – Eight questionnaires back so far. When asked where they would like the EEG test to be performed, half still wanted to come to the hospital. Many wanted a phone call to discuss needs and anxieties coupled with a leaflet or online video. This was also reflected in how patients wanted to access information with post, phone call and internet as top scorers. Half of respondents also offered help to be involved in a focus group.

PDSA 3 – Similar results for 4-week breach date as January. Additionally, staff also now using annual leave before end of financial year.

PDSA 4 – Pasta poll going well, actively seeking feedback from the patients rather than parents / carers. 27 happy faces and 4 not sure. No sad faces.

March 2020

PDSA 7 -Too soon to get feedback from patients about additional resource and whether they have accessed

PDSA 2 – Questionnaires continue to trickle in with patients wanting more info and phone call before they come.

April 2020

Too soon to get feedback from patients about additional resource and whether they have accessed.

Have started to look at and plot our results.

Graph 1 below shows how we were initially able to improve our wait times after our EQIP training. Unfortunately, the knock-on effect of Christmas annual leave, reduced patients due to re-flooring and staff using annual leave at the end of the financial year has meant that we have slipped:

Graph 2 below shows an increase in the percentage of patients that we have been able to record a full quality EEG. (Note missing data for June-August). We have hit our target of over 95% since our EQIP training:

Additionally, we have not had to abandon any recordings since starting the project as shown in Graph 3 below:

Plotting both these together in Graph 4 (below) shows us that it is the wait times that have affected our overall ability to meet our aim but great that we have been able to make a difference by communicating with each other and families to improve quality and hopefully experience for our patients:

Next steps

  • Contact parents and carers of difficult patients after the EEG to gain feedback on how we can improve. This hasn’t happened yet.
  • Possibility of having a dedicated time slot for parents / carers to ring the department to ask questions. Discuss with the team.
  • May need a department team member to help with admin side of distributing questionnaires and collecting data on a daily basis. To discuss with manager.

Definite theme coming through of parents and carers wanting to talk-the-visit-through with staff before they come.


Team presentations

Ms Helen Sneath, Trainee Consultant Scientist at Nottingham University Hospitals NHS Trust shares their EQIP team journey:

Nottingham University Hospitals’ team presentation for the EQIP celebratory event describing their journey and improvement project based on their aim to achieve quality routine EEG recordings in 95% of all paediatric patients referred within 4 weeks from referral:


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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