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Enhancing Outpatient Services for Improved Patient Experience and Clinic Efficiency

Explore successful transformation in Outpatients Department, focusing on improvements in clinic operations, patient satisfaction, and resource utilization. Learn how strategic changes led to better services, timely appointments, and streamlined processes, benefiting patients and staff alike.

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Enhancing Outpatient Services for Improved Patient Experience and Clinic Efficiency

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  1. TRANSFORMATION IN PRACTICE Marie Keane Director of Nursing

  2. Performance Measurement Framework – Balanced Scorecard Financial To succeed financially – how do we remain within our allocated budget and ensure value for money? Patient Satisfaction To ensure the highest standards of quality of diagnosis, treatment and care – how do we ensure patient satisfaction? Internal Processes To ensure effective and efficient delivery of services – what key patient administrative and business processes must we improve and excel at? Employee Dev. & Growth To retain our status as a leading edge healthcare provider, contribute to service and medical developments – how do we sustain our ability to adapt and change? 2

  3. Medical Short Stay Unit 3 Clinics a day project

  4. GUIDING PRINCIPLES • Improving Access • Improving Quality • More Efficient Resource Utilisation

  5. OUT PATIENTS DEPARTMENT

  6. OPD – Important Gateway • Over 135,000 patients seen each year • 27,000 new patients each year • 108,000 return patients • 100 clinics per week • All disciplines/specialities are covered

  7. Background • 70% Clinic space only utilised • Appointment times were not being adhered to • Clinics were not starting or finishing on time • Some clinics were overbooked – others were under-booked • Waiting times for some specialties were 12-24 months

  8. Background cont’d • Lack of discharge planning in some of the specialties • The ratio of ‘new’ patients to ‘return patients was low • High rates of patients not attending (D.N.A’s - 22%) • Continuing complaints from patients.

  9. The ‘Solution’ • Extend the ‘clinic day’ - 8am - 6pm • Change to three clinic sessions per day viz 8am -11am, 11.30-2.30, 3pm-6pm (was 9.00 to 12.30and 2.30-5.00 over two sessions) • Patient Attendance by appointment times • Additional consulting rooms provided

  10. What was involved ? • 16 New rooms were added as part of a refurbishment of O.P.D. • 100 Clinics needed to change – medical, nursing and secretarial staff and patients • 35 ‘New’ clinics spaces were created • All stakeholders consulted and brought on board

  11. What was involved? (cont’d) • Templates of existing clinics were developed and new ones designed to suit each speciality, giving number of New/Return Patients per Clinic • High level of communications with all stakeholders • Started October 2006 on pilot basis

  12. Critical success factors • Co-operation and goodwill of all staff – senior management support • Improved physical infrastructure – showed that we were serious • Good communications – to avoid confusion, misunderstanding etc • Dedicated project resources • Streamlining services for the patients • Continuous auditing of how clinics were progressing

  13. Present position • 35 Additional ‘new’ clinics with no additional resources • Continue to monitor the changes in O.P.D. • Review work practices and procedures • Expansion of Nurse Led Clinics • Continued involvement of all staff • Continued emphasis on education & and informing patients of what is required of them • DNA Policy • Focus on discharging Patients to G.P

  14. OUTPATIENT ACTIVITY

  15. Benefits • More patient-focused service • Patients are seen in a more timely manner • Clinics are running to time • Extra space and time slots allows for new consultant Appointments • More efficient use of medical, nursing and clerical resources • Positive feed-back from patients – Patient Satisfaction Study completed • Better working environment for staff – less overcrowding

  16. WAY FORWARD: • OPD need to link with A&E to provide rapid access for patients • Extend Clinics to 8pm • ↓ DNAs - <5%. (Policy Implemented) • ↓ Waiting Times For Appointments • ↓ Returns Attendance • ↑ New Attendances • Web site displaying the OPD clinic sessions per Consultant to be completed • An active approach to discharge planning from OPD to G.P.

  17. WAY FORWARD continued.. • Options for closer ties with the Community need to be examined. • Standard Referral from G.P. • Auditing and Monitoring of adherence to practice changes. • Extend Nurse Led Clinics. • Patient education through appropriate use of TV, DVDs and information leaflets. Access • Focus on Healthstat Integration & Dashboard Results Resources

  18. St Patrick’s Short Stay Unit (SSU)

  19. CHALLENGE • Reducing Patient Waiting time in E.D • 31 Bedded Medical Ward • 20 (Approx) Long Stay Patients • Average 1-2 Discharges per Day • In need of Refurbishment

  20. DESIRED OUTCOMES: Protection of Ward, despite 40 +++ in E.D. Reduced LOS. Patient Pathway measured in hours. Timely access to diagnosis. Change in culture, more efficient in tests. Integrated Discharge Plan. Establish LOS. Improved MDT/Education ownership. Micro-management approach. Increased awareness of nursing staff re short stay. Extended nursing roles – Phlebotomy out of hours, Cannulation out of hours, ECG out of hours. Rigorous Audit. Allocated Medical staff. Bed Management focus on Case Management. Nurses → E. D. Increased staff morale. Mixed bays. BACKGROUND

  21. Opened 27th July 2009 • 30 Inpatient Beds –including MRSA 4 bedded Cohort • 3 Bedded Trolley Area for Rapid Diagnosis. • Open 24 Hours Per Day 7/52.

  22. EMERGENCY MEDICAL PATIENTS (Short Stay) • Emergency Medical Patients within an expected 3 Day LOS • An Agreed Pathway/Protocol. • Emergency Department Patients Assessed In Trolley Area.

  23. Short Stay Unit • UNPLANNED OUTCOMES • Impact on Core Ward Activity. • Impact on Specialisation, therefore impact on training nurses. • Increased Long Stay Patients throughout hospital. • Decrease staff morale/satisfaction in other wards. • Loss of Private Income for Hospital. • ↑ Patient Dependency in Wards/Admission Lounge. • Nurses in St. Patrick’ s Ward have attained what all nurse in wards should attain – Teamwork ↑………

  24. SUCCESS FACTORS • Senior Clinical Decision Making. • Access To Diagnostics. • Multi Disciplinary Team Approach • General Services Support – Portering, Cleaning, Catering. • Guarantee approx 33% Ward Bed Turnover.

  25. STATS • 27/07/09 – 29/10/09 95 Days Open • 837 Patients through the unit (includes trolleys) )Approx 7-8 patients daily) • Overall LOS 4 days • 3.8 days if long term care patient excluded

  26. REVIEW OF LENGTH OF STAY PER DIAGNOSIS FOR PATIENTS ADMITTED TO THE SHORT STAY UNIT

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