Ear Nose and Throat (ENT) is a challenged speciality for Referral to Treatment (RTT) and has a high demand for consultant-led outpatient appointments. The transformation team at MFT worked with the service to identify opportunities for releasing capacity to see new patients by:
- Mapping booking and scheduling pathways
- Analysing data for all sub-specialties including activity and capacity and demand
- Interviewing staff to identify areas of good practice and opportunities to improve
- Reviewing compliance against national guidelines and identifying potential new models of care.
Numerous improvement opportunities were identified including reducing the number of inappropriate referrals, reducing the time to first appointment, reducing the number of diagnostic delays, reducing the number of follow-up appointments and redirecting activity to Tier2 services.
Workshops were held with both clinical and operational staff to identify the actions required for each improvement area and to identify alternative models for outpatient appointments. The initiatives identified will result in an increase in productivity and efficiency and include:
- Advice and guidance service for GPs and GP referral protocols for Globus patients to reduce the number of patients discharged at first appointment due to inappropriate referrals. In the Neck Lump Service during 2018 there were 500 patients discharged at first appointment. A target reduction of 25% would release 125 appointments per year.
- Hoarseness and general balance MDT clinics to increase the capacity of the number of patients that can be seen in consultant-led clinics. Increasing the number of general balance patients who could be seen during a consultant clinic by 1.5 times could enable an extra 90 patients to be seen per year per consultant.
- Increase in ENT diagnostic reporting capacity, prompt for safety blood requirements on the diagnostic laboratory request system and local phlebotomy to reduce delays due to diagnostics. An increase in reporting capacity has reduced the diagnostic reporting backlog by 50% over six months.
- Head and neck cancer follow-up schedules and nurse-led follow-ups, allergic rhinitis one stop clinics, and well defined discharge criteria for Globus patients to reduce the number of consultant-led face to face follow-up appointments. A target reduction in face:face consultant follow-up appointments for the neck lump service by 20% releasing 670 appointments per year.
- Chronic rhinitis open access follow ups to reduce DNA rates due to greater patient choice – a reduced DNA rate will enable more patients to be seen with the same amount of resource. In Rhinology there are currently DNA rates of up to 24% for follow-up appointments. A target reduction in DNA rate to 12% would create an opportunity for 530 more patients to be seen per year.
The combined impact of these initiatives will increase capacity in the ENT service for in excess of 1,000 additional appointments per year.