Maximising service capacity and capability

Remobilising during COVID-19 will require elective care services to reassess their capacity and capability as they adjust to new circumstances. Innovations presented here illustrate how teams are using different tools and resources to deliver care in a sustainable manner.

Designing a physical capacity tool for organisation-wide remobilisation

The introduction of COVID-19 restrictions meant many services had to scale back their elective care activity, reducing capacity across the organisation. To help ensure safe remobilisation of services, a team in NHS Fife developed a new physical capacity tool which is now embedded in NHS Fife governance structures and it has been adapted for use in community settings. Find out more in our innovation summary.

Telephone clinics and enhanced vetting reduce waiting lists by up to 50%

To continue delivering care whilst unable to see patients face-to-face, colorectal consultants at NHS Tayside introduced enhanced vetting and a new telephone clinic. Find out more in our innovation summary.

Using SPC charts to provide assurance during COVID-19

To aide decision-making at pace during COVID-19, the Health and Business Intelligence (HBI) Team at NHS Tayside created a tailored Statistical Process Control (SPC) chart template to present data in an easy to read manner. Find out more in our innovation summary.

Digital rehabilitation increases staff capacity and keeps patients safe

Digital rehabilitation being incorporated into the orthopaedic pathway has been invaluable to Calderdale and Huddersfield NHS Foundation Trust. The pathway provides the opportunity for teams to increase staff efficiency and capacity.  Find out more in our innovation summary.

Working with health and social care partnerships to reduce waiting lists

The Care Home Dietetic team in NHS Greater Glasgow and Clyde anticipated that referrals would rise significantly during COVID-19. To manage this, they worked at pace to produce helpful guides and avoided a spike in referrals. Find out more in our innovation summary.

Using infographics to increase staff confidence and reduce the need for clinic consultation

The use of infographics to support both patients and staff can reduce the need for clinic consultations, and help staff gain knowledge and confidence in the care they are delivering. One team adapted their information guides, all of which have received extremely positive feedback. Find out more in our innovation summary.

Taking the clinic on the road

When access to face-to-face homeless health services was paused in response to COVID-19, a team from NHS Greater Glasgow and Clyde Sandyford were able to quickly adapt their mainly clinic-based service to one they could deliver almost entirely from a van. This approach enabled them to widen their reach and help support a vulnerable population in the community. Find out more in our innovation summary.

Designing a Patient Initiated Follow-up Pathway to improve quality of care

To successfully design and implement a new pathway requires teams to better understand their outpatient capacity against the needs of their patients. There are a number of ways this can be done. Read a team in NHS Lanarkshire’s experience in our innovation summary.

Online videos help staff deliver care

Teams can reduce the need for follow-up appointments by providing patients with additional information about how they can self-manage their condition. However, the information must be easily accessible and user-friendly. In partnership with a digital health agency, a Trust has developed an online health and care video library to help support staff and service users. Find out more in our innovation summary.

Sharing learning across the airways

Remobilising elective care during COVID-19 sees many teams facing the same challenges. To help share learning, one Trust has launched a QI podcast channel. Find out more in our innovation summary.

Existing guidance for resuming elective care services

Teams face a number of challenges as they seek to remobilise their elective care services with COVID-19 impacting on their service capacity and capability. To help guide staff, a number of organisations have published resources highlighting key considerations and a variety of innovative solutions that can be implemented at pace. A great resource available to staff are the regularly updated clinical guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). During COVID-19, SIGN have produced a number of resources to help staff respond to new challenges during the pandemic. Most recently, in collaboration with Scottish Government, SIGN have released rapid guidance on reducing the risk of postoperative mortality due to COVID-19 in patients undergoing elective surgery. It provides extensive advice on the pre-operative assessment and isolation of adult and paediatric patients. The guidance is available on the SIGN website.

To provide further support, the Access QI team This has created a round-up document which provides a brief overview of some additional available guidance, as well as links to ready-made tools such as safety assessment tools, patient information guides, downloadable checklists and possible case prioritisation scoring tools.

We hope this will be a useful initial reference for elective care teams. Guidance included is from the following organisations:

• The Royal College of Surgeons of England
• NHS England
• Academy of Medical Royal Colleges
• American College of Surgeons
• British Orthopaedic Association
• The Association of Coloproctology of Great Britain and Ireland
• American Academy of Family Physicians
• Centers for Disease Control and Prevention
• Royal College of Surgeons of Edinburgh (RCSEd)

You can find further information in the round-up document of existing guidance for resuming elective care services.

Maximise your service capacity by keeping patients informed

Before coming to hospital for treatment during COVID-19, it is important patients are fully prepared and feel confident about the care they will receive. Doubt, anxiety and being unprepared could cause delays, affecting service capacity. To address this and ensure patients are fully informed and ready for their surgery, NHS Greater Glasgow and Clyde have created a user-friendly patient information leaflet. Find out more in our innovation summary.

Using pre-clinic telephone consultations to reduce clinic waiting times

Conducting pre-clinic telephone consultations has helped a team in NHS Ayrshire and Arran continue to run their postmenopausal bleeding (PMB) clinic at full capacity throughout COVID-19. They have also reduced waiting times for ‘urgent suspected cancer’ cases. Find out more in our innovation summary.

Understanding your pathway: The ‘Last 10 Patients’ QI tool

Experience of NHS Lothian Dermatology pathway

Tested before the outbreak of COVID-19, NHS Lothian’s Dermatology team used the ‘Last 10 patients’ QI tool to understand patient flow within their pathway to identify their longest waits. The tool and an associated summary are available on our Tools and Resources page and you can read more about the team’s experience in this case study.