13 / 06 / 2013
Aintree University Hospital NHS Foundation Trust (North West Region) is a single site 700 bed hospital in Liverpool providing general and community services for 330,000 local residents and special services for 1.5 million people. The trust is part of the Major Trauma Centre Collaborative and is a centre of excellence for head and neck care.
What we did and why
We recognised that our patient services were not as streamlined or efficient as they could be. Retirement of the consultant audio vestibular physician provided an opportunity to review the workforce and patient pathways for tinnitus and dizziness conditions.
The previous care pathway model involved an initial patient assessment in a consultant-led clinic. Investigations were arranged for later dates and patients were sometimes referred to physiotherapy and/or audiological management for treatment of their symptoms.
It was decided this process was unnecessary and that the roles of physiotherapists and audiologists could be extended to allow them to run their own one stop clinics.
How we did it
After auditing the department’s capacity and demand, key stakeholders met to discuss and redesign the new patient pathways.
A workforce risk assessment was carried out informally following the individual training needs analysis. The key aim throughout was to deliver excellent streamlined audiology and associated services and to be the patient's centre of choice for hearing, balance and tinnitus services.
Stakeholders consisted of representatives from management, patient appointments, ENT consultants, audiologists and physiotherapists. Patients from the tinnitus support group were also asked to become part of a patient focus group.
A project plan including timescales was developed to ensure the service redesign moved forwards to timescales.
Skills were extended after an individual training analysis to enable staff to, for example, deliver new roles such as wax removal and to request MRI scan referrals effectively, ensuring the smooth running of one-stop clinics. Staff were fully engaged in this process and training was delivered in-house. Clinic templates were set up on Choose and Book and patient letters set up to be electronically triaged on a daily basis.
Treatment started on initial patient visits include:
- semi-circular canal particle repositioning therapy (Epley manoeuvre)
- hearing aid assessments
- opportunistic hearing aid fittings
- tinnitus therapy.
Results and Next Steps
More than fifty per cent of patients are now assessed, managed and discharged in one visit.
The changes have put patients at the centre of service re-design. Each new patient has a linked hearing test (applicable to everyone – this avoids bottlenecks and clinic delays) prior to their consultation. Eighty five per cent of cases can be completely managed by allied health care professionals with the remaining fifteen per cent requiring fast tracking to the appropriate ENT clinic.
Therapies, if needed, are begun at the initial visit, reducing the need for further appointments. One hundred per cent of tinnitus cases requiring therapy begin treatment at the initial appointment.
Patient satisfaction surveys have demonstrated that all patients are satisfied with the new service and over ninety per cent have given top marks.
A safety audit performed by ENT consultants has verified that clinical competence, patient safety and protocols have been adhered to. An audit of cross-referrals to ENT found one hundred per cent of these to be appropriate. Feedback from patient forums is positive.
Other trusts have expressed an interest in the new model which is transferable. The project won the 2012 Advancing Healthcare Awards, Rethinking the patient journey category.
Tips for other trusts
- Engage and communicate with all stakeholders at the very beginning to encourage ownership of change.
- Develop a project plan using lean thinking to get it right the first time with clear timescales.
- Ensure the effective triage of referrals.
- Have clear clinical accountability with effective clinical governance/quality assurance.
- Carry out regular audits.
- Carry out reflective practice.
- Protected non-clinical time is needed to support the clinics.
Tony Kay, Head of Audiology Services
0151 529 0328