Telephone clinics and enhanced vetting reduce waiting lists by up to 50%
At the start of lockdown many teams found themselves unable to see patients or deliver routine care due to COVID-19 restrictions. Whilst urgent colorectal care continued during this time at NHS Tayside, all other appointments were postponed. Colorectal consultants decided to use this time to introduce enhanced vetting with the aim of reducing existing waiting times for both new and returning patients. By adopting a flexible approach, that consultants could adjust to suit their needs and preferences, the team have successfully been able to reduce their waiting list for new routine appointments by over half in the space of a few months. Additionally, due to the success of the new telephone appointments, they are now taking a hybrid (face-to-face and telephone appointment) clinic model forward to maximise their clinic capacity whilst adhering to social distancing protocols.
Here are some key steps and recommendations shared by the team to help others looking to adopt a similar process.
1. Ensure that consultants have up-to-date information regarding their waiting list
The team identified that a key initial step was providing each consultant with reviewed and accurate figures about which of their specific waiting lists (new or returning patients) were the longest. This allowed the consultants to prioritise their workload as appropriate and helped identify a number of patients who needed reallocation. This process also identified that a number of patients required reallocation.
2. Identify any training needs
Not all team members were as familiar with TrakCare as others. Therefore, setting up run-through discussions was prioritised from the outset. Ensuring staff felt comfortable with the system and were able to navigate it with confidence was essential to undertaking this work at pace remotely.
3. Pick a suitable mode of communication and appointment format
The team explored a number of communication options and soon realised that standard telephone calls would be most effective and efficient for their needs, particularly with some staff shielding and working remotely. They needed a system that would allow the team to work from any location and without restrictions in allocating appointment times. Patients received a letter stating a time for their phone appointment. They would be phoned up to four hours after that appointment. If the clinician was not available at short notice, the patient would be phoned within 48 hours of their appointment. Contact with patients was attempted on two occasions and then re-appointed if appropriate. The team found they could deliver the clinic effectively and efficiently with few technical difficulties.
4. Does the patient still need their appointment?
The team found that some patients had been on the waiting list for an extended period time and were no longer symptomatic. By calling the patients, they were able to give reassurance and provide an open appointment (patient initiated review) should symptoms reappear. The patients were provided with details of an appointment booking service they can call to schedule a time to come into hospital. Some patients were discharged at this point as well.
5. Spread the learning
The team have found that whilst patient responses deteriorated as restrictions were relaxed and routine daily life was re-established, the success of telephone appointments was evident. The majority of the success in telephone appointments have been with either return patients (not new) or as a triage tool for new patients. Therefore, the team have decided to incorporate this into their future clinics alongside face-to-face appointments.
This process ensures that safety precautions are maintained and clinic capacity can be maximised. The team have also shared their experiences and have encouraged other teams to consider the same approach when 100% face-to-face appointments are not available.