Heart of England NHS Foundation Trust is one of the largest in England, with more than 11,000 staff delivering care from four major hospitals and several satellite units, where patients can be treated close to home.
The trust needed to streamline its outpatient appointment system across several hospital sites, in a way that was fully Choose and Book compliant, and would prevent overbooking of appointments. Importantly, it wanted to reduce a high ‘did not attend (DNA) rate’ for outpatient appointments, which was running at around 14% - and above the current national average.
It also wanted to harmonise processes at each site, to maximise efficiency and improve patient care, while developing a new finance and billing system. Historically, there had been no mechanism for accurate delivery of patient pathways, to ensure adherence to waiting times or safeguard against patients becoming ‘lost in the system’.
The solution – UltraGenda
iSOFT’s UltraGenda enterprise scheduling solutions deliver proven booking and referral capabilities to trusts. They also provide clinicians with the right information, let them manage their own clinics and diaries, and check on DNAs; helping them keep patient care and patient pathways on track.
Trust IT manager Jonathan Daniels says: “UltraGenda has allowed us to unpick the existing service and completely reconfigure it.” However, implementing UltraGenda across one of the largest trusts in the country posed an inevitable challenge to a small IT department and demanded an incremental approach.
Choose and Book: Early achievements have resulted in a Choose and Book pathway for outpatient appointments, which has invigorated outpatients’ services. DNAs have reduced significantly, from 14% to less than 10%, through a range of initiatives. These include telephone reminders to patients, using data pulled from UltraGenda.
Finance department and RTT compliance: A finance project also paid dividends, resulting in a greatly improved billing system that records treatment more accurately, and helps to make sure that funds are paid for the delivery of patient services.
Using UltraGenda, the trust’s IT team also developed a reliable mechanism for measuring and monitoring referral to treatment times, which can be used to submit accurate returns.
“While the present government has relaxed the 18 week waiting time, local primary care trusts still expect their patients to start treatment within 18 weeks,” says Daniels. “Using UltraGenda, we can accurately monitor compliance by calculating the gap between two key dates – referral and start of treatment.”
Patient pathways: The trust’s home grown patient management system enabled the creation of patient pathways, which encompass all patient activity based on quality of care, while also ensuring RTT compliance.
The ability to separate inpatient and outpatient activities lets clincians see exactly where a patient is in their treatment pathway.
“Our PMS has given us control over pathways and recording episodes, while UltraGenda allows us to schedule everything and manage referral processes; something traditional approaches cannot do,” Daniels says. “From there, RTT and any other monitoring becomes relatively easy.”
Following these successes, the trust’s IT team is working to further exploit UltraGenda’s capabilities across its services, including the Sleep Clinic, based at Heartlands Hospital.
Change is always perceived as potentially disruptive and Heart of England has seen some understandable resistance on the part of both clinicians and booking staff. It has therefore taken time for UltraGenda and the efforts of the implementation team to gain credibility.
However, by talking and collaborating with doctors and end users and by demonstrating that UltraGenda does improve working practices and helping deliver more effective patient care, staff are now largely supportive.
Based on the successes so far, Heart of England is confident that UltraGenda can support every hospital department, and it continues to be ever more tightly integrated across the trust’s IT infrastructure.
This includes extending its use in theatres, so that each theatre, consultant and piece of equipment becomes a bookable resource for the time required.
Within the trust’s breast clinic, UltraGenda will be used to book a series of procedures as a complete order set, to ensure clinics are managed as smoothly as possible, with clinicians able to view their own diaries and their own patients.
Admission, discharge and transfer interactions (ADTs) are being moved from the trust’s PMS to UltraGenda. And while there were no plans to use UltraGenda for bed management, it is already being used for day surgery bed management at Good Hope Hospital.
Eventually, the system will be used for managing all elective surgical procedures and inpatient referrals. UltraGenda is already accessible to a large number of local GP surgeries, for them to view relevant patient information.
It is hoped that this connectivity will start to be exploited within the local primary care community. And the trust plans to install UltraGenda Broka and UltraGenda Track Pro, with a view to developing a patient information portal for ‘true patient empowerment’.
UltraGenda’s capabilities are even being used to improve paper processes; the trust is currently scanning all its paper records and using UltraGenda to facilitate ‘intelligent paper’ through categorisation of documentation, for more efficient management of information.
Rheumatology partial booking pilot
A rheumatology pilot based on 11 patient pathways mapped by the clinical director and general manager is set to transform delivery of care. Each pathway is based on a series of appointments within specific timescales, which vary depending on diagnosis and treatment plan.
Under the previous system, follow-up appointments were sometimes booked months in advance. Scheduling referrals so far ahead inevitably meant that by the time the appointment was due, circumstances could have altered significantly. For example, a consultant might have left the trust, the clinic might have been suspended, or the patient might have forgotten the date.
Booking appointments so far in advance can also lead to patient safety issues if an appointment is missed and has to be rescheduled, potentially resulting in patients being rebooked months ahead again, with the risk of becoming completely ‘lost in the system’.
With partial booking, appointments due within the next four weeks are booked as usual, while booking requests are generated for appointments further into the future. An appointment is then automatically generated four weeks before the next appointment is due, and a notification sent to the patient.
Managing follow-ups in this way ensures appropriate treatment pathways are maintained and eliminates overbooking issues, which can lead to cancelled appointments and potential patient safety issues.
“Quite simply,” says Daniels, “we think UltraGenda is the best scheduling system available. It is easy to set up and use, and across almost all areas, we are able to harness UltraGenda’s capabilities to weed out manual processes, saving time and reducing the potential for error.”
Over the past 18 months, Heart of England’s implementation of UltraGenda has started to reap significant rewards. This success has been down to the commitment of an enthusiastic IT team that has carefully analysed its appointment systems, listened to clinicians and administration staff, understood the need to deliver reliable patient care, and been confident that UltraGenda was able to deliver all these requirements. However, the trust is confident that this is just the beginning.