AUDIOLOGY AND ENT
and new pathways.
Patients, commissioners, managers and clinicians (all grades) provided direct input into the piloting and prototyping phase. New pathways and a redesigned procedure were introduced, reducing clinic time for most patients and improving the department’s ability to manage capacity. Services are now provided in a range of community locations with more than 5,000 patients offered this ‘closer to home’ treatment. Evaluation has shown patient visits fell by 46% and the time spent in clinics dropped 43% ensuring a greater number of patients can be seen within existing resources - demonstrated in the diagram below. There are now further plans to provide similar services in
Old Pathway Referral Repair
with triage (15 mins)
Reassess (45 mins)
Fitting (60 mins) Discharge
Min-max time (60- 120mins)
New
reassess (30 mins)
Further reassess (60 mins)
25% Discharge 50%
Min-max time (30- 90mins)
Fitting (45 mins) 25% New Pathway
Telephone triage and referral
from ENT, DNAs and variation in capacity due to staffing leave.
Activities that delayed the consultation process (eg clinic room stock levels being low) were identified and overcome. Some tasks were simplified and combined – for example, patients agreeing a follow-up appointment while at the clinic. Telephone follow-up and partial booking were implemented to reduce DNAs. Waiting times have been reduced from up to 28 weeks to less than four, with fewer follow- up appointments required. Since the end of the prototype phase, around 250 patients have used the service and it has progressed with a second audiologist now supporting the clinic and a satellite clinic set up at Newark Hospital providing treatment ‘closer to home’.
additional locations in the future.
The audiology team at Sherwood Forest Hospitals NHS Foundation Trust identified that up to 73% of GP referrals to ENT (ear, nose and throat) outpatient clinics met the direct access audiology service criteria for tinnitus management. Patients reported that delays in accessing services added to the emotional impact of tinnitus and that professionals were providing inconsistent information.
New guidelines were drawn up to allow GPs to refer directly to audiology clinics or via an agreed pathway to ENT. These services are provided by audiologists and hearing therapists who have access to ENT
consultants and can request MRI scans if required.
Core measures were identified and agreed with patient focus groups. These were seen as key to establishing whether any implemented changes were a true improvement – or just added more variation into the patient pathway. To demonstrate quality and productivity benefits, the measures included:
clinical outcomes,
process, defects, patient satisfaction and staff satisfaction. Variation in the referral to assessment times were identified by use of statistical process control (SPC) charts (see diagram). Root cause analysis on the outliers from mean also identified issues such as delays in redirection of referral
Michelle Booth, clinical lead for Adult Audiology at the trust, is now cascading this good practice to other audiology professionals across the country and is working with both the British Tinnitus Association and GPs to promote the work and help further improve management of tinnitus patients.
One of the patients who has benefitted from the new approach added: “I was one of the first patients to use the new unit. They had time to look into my condition in detail and fitted me with new digital aids.
“With the aids on, the noise is almost not there at all.
“I am forever indebted to the work of the staff at the unit.”
Fiona Thow
FOR MORE INFORMATION
www.improvement.nhs.uk
national health executive Mar/Apr 12 | 49
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84