Royal Pharmaceutical Society Scotland, Edinburgh, UK.
Department of Nursing, University of the Highlands and Islands, Inverness, UK.
BMJ Open Qual. 2021 Mar;10(1). doi: 10.1136/bmjoq-2020-001259.
Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service systems for clinicians and non-clinical staff, and automated much of the administrative burden. All clinicians and staff are using the system and both groups identified benefits in terms of travel time and costs saved. Transferable lessons for other services are identified, providing a practical blueprint for others to adapt and use in their own contexts to help implement and sustain video consultation services now and in the future.
日益增长的门诊预约需求（OPA）是全球医疗服务提供者面临的一项挑战。未到场率居高不下，部分原因是由于交通困难、费用、健康状况不佳、照顾和工作责任等原因，患者难以参加医院的 OPA。数字解决方案可能有助于缓解这些挑战。本项目旨在通过系统范围的质量改进方法实施 NHS 高地的门诊视频咨询，涉及患者、护理人员、临床和非临床人员、国家和地方战略领导。系统映射；涉及广泛利益相关者参与和实时测试的密集型共同设计过程；计划、执行、研究、行动循环；以及收集临床医生和患者的反馈，用于优化服务。制定并实施了标准化流程，使患者易于使用视频咨询，使临床医生和非临床人员将视频嵌入常规卫生服务系统，并自动完成大部分行政工作。所有临床医生和工作人员都在使用该系统，两组人员都认为在节省旅行时间和成本方面受益。确定了可用于其他服务的可转移经验教训，为其他服务提供了一个实用的蓝图，以便在自己的环境中进行调整和使用，以帮助在现在和将来实施和维持视频咨询服务。
