Written by Camilla Somers, Knowledge and Information Skills Specialist
10 December 2020

The ‘Remobilising elective care’ webinar series is part of the Access learning system, providing services across NHS Scotland the opportunity to share their experiences and learning with others. For details and blogs by the team about previous webinars you can check out the Access QI updates. During this webinar, NHS Fife and NHS Ayrshire and Arran presented how they are maintaining service capacity and capability whilst also enabling services to manage their physical environment.

Designing an outpatient capacity tool for organisation-wide remobilisation

Firstly, Stephen McNamee (Programme Manager, Transformation and Change Team), Fiona McIver (Service Improvement Coordinator, (Unscheduled Care)) and, Belinda Morgan (Clinical Services Manager, Fife Health& Social Care Partnership) from NHS Fife presented a new tool they developed to create a data informed approach to organisation-wide remobilisation. In March 2020, the Board asked services across NHS Fife to scale back activity and apply social distancing restrictions, immediately reducing their capacity. Therefore, in order to provide assurance that services could safely increase the number of clinics being held, while staying mindful of the increased footfall this would create, the team developed an outpatient capacity tool. The tool is designed to help services plan their clinics, by determining how much space they require with the inclusion of key data such as, average time per appointment, number of treatment rooms the clinic requires, and even the percentage of patients that are expected to attend alone or with a companion. This ensures the total capacity of the site is maximised whilst also adhering to safety precautions.

The team mapped the entire estate by walking the patient’s expected journey onsite for each clinic in order to identify all variables and possible complexities (such as elevator capacity limits during COVID-19 when departments sit on multiple floors) that would need to be considered. Additionally, the tool was developed to be, as much as possible, futureproofed. The team incorporated different social distancing options into the excel tool to ensure services could quickly calculate any changes in their capacity should pre-COVID safety protocols be reinstated. The tool also incorporated the option for services to include NHS Near Me and telephone consultations to ensure a clinic’s entire capacity was considered. The webinar attendees were also shown a live demonstration of how the tool functions, highlighting how it enables services to work as a collective and improves outpatient access across the whole organisation. It has now been used in multiple sites and is firmly embedded in care delivery as part of the NHS Fife governance structure. All clinics being remobilised must use this tool. A detailed case study on this work is currently under development and will be published via the Access QI website, so please look out for updates.

Using QI to take learning into practice: a new change package from Access QI

Secondly, attendees then heard an update from the National Programme Director for Access QI, Thomas Monaghan who demonstrated how the programme are creating new tools and based on the innovations and challenges we are hearing from staff from across the system. He presented a change package developed to enable services to take a QI approach to managing their physical environment. 

How pre-clinic telephone consultations can maximise capacity and reduce waiting times

Lastly, Dr Joy Simpson (Undergraduate Lead and Consultant in Obstetrics/Gynaecology), from NHS Ayrshire and Arran presented how her team had continued to run their post-menopausal bleeding (PMB) clinic at full capacity throughout COVID-19. Their three main challenges were:

• how to minimise risk of COVID-19 transmission and ensure staff and patient safety
• how best to triage and promote appropriate attendance at the clinic for those at risk of underlying endometrial pathology, and 
• providing a diagnosis and treatment for the cause of the PMB in a safe environment and ensuring continuity of care.

By introducing new vetting processes and contacting patients in advance of their appointments, the team were able to ensure both that prioritised patients attended clinic, and that patient anxiety about attending appointments during COVID-19 was reduced. This telephone consultation was also documented so that prior to attending clinic, the history and plan of care was already fully discussed. This both reduced patient’s length of visit, and allowed a quicker transition through to the diagnostic facilities in the clinic. Between March and November the team saw approximately 1500 patients despite having to relocate the clinic three times. The full innovation summary of this work is available on the Access learning system.

What next?

The event was then closed by Access QI Improvement Advisor, Colette Dryden who announced that a new series of webinars will be launched in February 2021. Keep an eye on our updates and twitter #AccessQI to find out more in the New Year.

Sharing learning with others can help accelerate change across the system. If you have a local innovation or project on changes to elective care pathways you wish to share complete this form and email us at his.accessqi@nhs.scot