Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
BMJ Open Qual. 2023 Jul;12(3). doi: 10.1136/bmjoq-2023-002317.
Transthoracic echocardiography (TTE) is one of the most requested non-invasive cardiac imaging diagnostic modalities available in the National Health Service (NHS). There is persistently high demand, but nationally, activity has lagged, producing increasing numbers of breaches of the 6-week waiting time target. This delays patients' diagnosis and treatment.Patients attend hospital for TTE either as a clinic-linked or a standalone appointment. In this quality improvement project, we identified that the clinic-linked slots were a major source of wasted capacity due to both unbooked slots and a high rate of patients not attending their appointments (DNA).DNA is a complex issue, aggravated in our trust by many IT systems, complex clinic-booking pathways and restricted patient communication channels. We parked changing these processes, pending an imminent, unifying IT development programme. We focused instead on unused clinic-linked appointments, with the goal of reducing these from 18% (~31 of ~175 allocated each week) to 5% by the end of the 14 week project period.In close collaboration with service stakeholders, we identified that the primary root causes were related to the clinic-linked TTE booking pathway. The change idea was a 7-day rule: after reminders at 9 and 8 days prior to the clinic date, any appointment slots still unbooked by cardiology sub-specialities for patients attending clinic-linked appointments at 7 days, would be used for booking standalone TTE patients.We refined this process over two plan-do-study-act (PDSA) cycles, reducing unused (wasted) appointment slots, allocated initially to clinic-linked patients, to a sustained level of 5.1%, meaning we could now perform approximately 21 additional TTE tests weekly; we have materially increased activity without increasing capacity.This contributed to a significant reduction in 6-week TTE waiting-time breaches. Over the project, this went from 378 (30%, February 2022) to 71 (8%, September 2022) and latest data show 28 (4%, February 2023).
经胸超声心动图（TTE）是英国国家医疗服务体系（NHS）中最常用的无创性心脏成像诊断方式之一。尽管需求持续高涨，但全国范围内的活动却滞后不前，导致 6 周等待时间目标的违规情况不断增加。这会延迟患者的诊断和治疗。患者因 TTE 而到医院就诊，其就诊途径分为诊所预约和独立预约。在这个质量改进项目中，我们发现，由于未预约的时段和大量患者未按时就诊（DNA），诊所预约时段是浪费资源的主要来源。DNA 是一个复杂的问题，在我们的信托机构中，由于许多 IT 系统、复杂的诊所预约途径和有限的患者沟通渠道，问题更加严重。我们暂停了对这些流程的更改，等待即将进行的统一 IT 开发计划。相反，我们专注于未使用的诊所预约时段，目标是在 14 周项目期间将其从每周 175 次预约中的 18%（约 31 次）减少到 5%。在与服务利益相关者的密切合作下，我们确定主要的根本原因与诊所预约 TTE 预约途径有关。变更想法是 7 天规则：在就诊日期前 9 天和 8 天进行提醒后，如果心内科专科仍未为参加诊所预约的患者预约任何预约时段，这些时段将用于预约独立 TTE 患者。我们在两个计划-执行-研究-行动（PDSA）周期中完善了这一流程，将最初分配给诊所预约患者的未使用（浪费）预约时段减少到 5.1%的持续水平，这意味着我们现在每周可以进行大约 21 次额外的 TTE 测试；在不增加容量的情况下，我们的活动量显著增加。这有助于显著减少 6 周 TTE 等待时间的违规情况。在项目期间，从 378 例（30%，2022 年 2 月）减少到 71 例（8%，2022 年 9 月），最新数据显示为 28 例（4%，2023 年 2 月）。
