Creating a one stop clinic to reduce pathway variation for patients with suspected cancer

A Urology service from NHS Lothian wanted to reduce the time from referral to diagnosis for patients with blood in their urine (visible haematuria). The team used process mapping, clinical outcome data and patient and staff input to locate areas for improvement within the pathway. They then opted to create a “one stop” diagnostic clinic for patients on this pathway. Learn more about their work here.


A virtual kidney clinic slashes waiting times and frees up consultant time for more urgent renal patients

Kidney consultants from Barts Health NHS Trust collaborated with local GPs to set up a virtual e-clinic. The e-clinic lets GPs send questions about kidney patients directly to a consultant and receive a quick reply, reducing the need for outpatient renal appointments. Click here to learn about this initiative’s impact on waiting times and access to renal care.


Managing ear symptoms in the community with digital hearing care

In hopes of streamlining patient pathways and reducing the number of hospital appointments needed, an NHS Trust in London decided to trial the TympaHealth device, an all-in-one hearing assessment tool. The device allows community audiology clinics to assess patients and remotely share images and videos with ENT specialists for advice. Learn more about the capabilities of the device and its impact on pathway efficiency here.


Treating nasal blockages in the community to reduce ear, nose and throat (ENT) waiting times

An NHS Trust in London set out to relieve system pressures and reduce waiting times for secondary ENT services. They conducted a pilot study to test whether a smart nose camera along with an online software platform could help primary care providers diagnose nasal blockages. They hoped the change would allow patients with nasal blockages to be treated in the community instead of being referred to secondary care. Click here to learn more about the smart nose camera and the impact of the pilot study.


Using endoscopic mobile imaging to streamline head and neck cancer pathway referrals

Ear, nose and throat (ENT) clinicians at University Hospitals of North Midlands faced increased pressures and difficulty keeping up with demand due to the COVID-19 pandemic. Because head and neck cancers have vague and ambiguous symptoms, referrals were frequently high for this category. The team decided to redesign their service using mobile technology that would support cancer diagnosis. They began to use endoscope-I, a cloud-based smartphone app that allows primary care clinicians to send endoscopic images to an ENT consultant for rapid assessment. Click here to learn more about the impact of this project on ENT services.


Reducing the number of appointments with Active Clinical Referral Triage (ACRT)

Due to a pause in non-essential work caused by the COVID-19 pandemic, the Musculoskeletal (MSK) Occupational Therapy (OT) Hand Clinic from NHS Dumfries and Galloway had increased wait times for patients with three common hand conditions. To reduce these wait times, promote self-management, and improve patient outcomes, the clinic staff initiated Active Clinical Referral Triage (ACRT) and sent self-management information to patients where appropriate. Read more about their use of ACRT and how it impacted the Hand Clinic’s waiting times here.


Remote pharmacist consultations enhance post-COVID-19 surgical capacity 

To address losses in elective surgery capacity during the COVID-19 pandemic, an orthopaedics team in NHS Greater Glasgow and Clyde began performing hip and knee arthroplasty as day case procedures. To support this new pathway, a multidisciplinary team came together to develop an innovative preoperative pharmacy service. Later, they used patient prescribing data, staff survey results, and patient feedback to determine whether the changes were successful. Click here to find out how the orthopaedics team implemented and then evaluated their new pharmacy service. 


Reducing waiting lists by converting a procedure from inpatient to outpatient

At the height of the COVID-19 pandemic in 2020, intravesical Botox injections for refractory overactive and neuropathic bladders were paused, as this was considered a less urgent procedure. By April 2021, NHS Lanarkshire Urology found that 52% of patients on the waiting list for this procedure had waited more than 18 months. The team decided to take this as an opportunity to streamline and redesign the service, with the intention of converting patients from general anaesthetic to a local anaesthetic treatment pathway. Click to learn how the Urology team shifted to outpatient Botox injections and reduced their waiting times.


Developing and evaluating a new joint replacement service

An Orthopaedics team from NHS Greater Glasgow and Clyde used the remobilisation of elective services after COVID-19 as an opportunity to expand their joint replacement service. After implementation, they reviewed patient records and developed a patient survey to evaluate the efficacy and safety of the new pathway. Learn more about the expansion and evaluation of the orthopaedics service in this learning summary.


Sustaining a waiting list reduction through testing and adaptation

Using Realistic Medicine principles, NHS Forth Valley’s Cardiology Unit achieved a sustained >40% reduction in their pre-COVID new outpatient waiting list. Aided by a shared vision and trusting colleague relationships, the cardiology team gathered unit-level data from TrakCare and implemented multiple change ideas that helped them deliver timely and equitable care during the height of the COVID-19 pandemic. Read more about their work here.


Using multidisciplinary triage and virtual delivery to reduce waiting times

Faced with increases in referrals and staffing pressures, the pain management service from NHS Greater Glasgow and Clyde felt their service model required radical changes. With the principles of Realistic Medicine and Active Clinical Referral Triage (ACRT) in mind, they established a multidisciplinary team that met weekly to discuss and triage patients to the right clinician at the right time. They also established virtual appointments and strengthened shared decision-making between staff and patients. Read more about this team’s work here.


Reducing an outpatient waiting list using a pre-existing culture of improvement and innovation

NHS Forth Valley’s Neurology Unit came together early in the COVID-19 pandemic to redesign their service using Realistic Medicine principles. They were not affiliated with a formal improvement programme, but utilised their existing enthusiasm for improvement and innovation to effectively improve their service. A scoping exercise focused on TrakCare data indicated that Active Clinical Referral Triage (ACRT) and waiting list validation processes could help remedy long patient waits and waiting lists. This led to the development and testing of several successful change ideas. Read more about this project here.


Improving waiting times and clinic flow in a tertiary diabetes centre

Due to inefficient processes and long in-clinic waiting times, the Diabetes Centre at Singapore General Hospital decided it needed to streamline clinic flow and ensure that appointment scheduling matched up with their demand. They performed a global assessment of all clinic processes, identified their key problem areas, and tested multiples change ideas pertaining to staffing, appointment scheduling, and patient flow. Click here to learn more.


Improving access to preoperative assessment for Urology cancer patients

A Urology service at NHS Belfast Health and Social Care Trust identified that patients with cancer who were awaiting certain elective surgical procedures did not always have access to preoperative assessment appointments. When they did have access, the appointments were often not timed well and the team was concerned that these patients were not being safely prepared and informed of the risks before their procedures.

After data collection, process mapping, and bi-weekly team meetings, they decided to focus on testing and refining one change idea that they hoped would have the biggest positive impact: protected slots at pre-assessment clinics for these high-risk patients. Through multiple testing cycles, they were able to successfully refine the change idea so that eventually 95% of these patients were receiving a full pre-op assessment before their procedures. Learn more about what they did here.


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 about NHS Lanarkshire’s experience in our learning summary.


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

As part of referral management, colorectal consultants in NHS Tayside used enhanced vetting and telephone consultancy to significantly reduce waiting times for new and returning patients. Find out more from our learning summary.


Using pre-clinic telephone consultations to reduce clinic waiting times

A postmenopausal bleeding clinic in NHS Ayrshire and Arran began contacting patients by phone prior to face-to-face appointments. This allowed them to check on patient wellbeing, ease any fears about upcoming appointments, and prioritise urgent cases. As a result, waiting times decreased and the clinic became more efficient. Find out how from this learning summary.


Smartphone app empowers patients with long-term conditions

New technology can help teams find creative, high-impact ways to connect with patients and reduce the need for in-person appointments while maintaining a high standard of care. A joint initiative between Chelsea and Westminster Hospital NHS Foundation Trust and ViiV Healthcare has designed a new app for patients. Learn more from our learning summary.