The Heart and Lung Clinic at St Vincent’s Hospital Sydney implemented a number of changes to the way it follows up and communicates external pathology results. This included the development of a new standard operating procedure (SOP), a dedicated area for reviewing patient files, new staff rosters, patient information brochures, patient database updates and standardised communication tools.
Aim
To ensure that within six months, 75% to 100% of patients who have bloods taken by external pathology services have their results followed up by clinic staff and communicated to them within three days.
Benefits
- Enhances patient satisfaction and confidence in the healthcare system.
- Improves the timeliness and quality of communication to patients.
- Improves patient safety by reducing the risk of adverse outcomes due to missed test results.
- Reduces the workload of nursing and medical staff by streamlining the system.
- Improves staff efficiency, allowing staff to focus on other clinical duties.
Background
The Heart and Lung Clinic at St Vincent’s Hospital Sydney oversees the outpatient management of all lung transplant recipients in NSW. There has been a 150% increase in clinic activity over the past 10 years, due to improved post-transplant survival rates and increased donor availability. This exponential growth in patient numbers has increased the workload of both clinical and nursing staff.
Lung transplant recipients need to have their blood monitored closely, so that immune suppression drug levels and end-organ toxicity can be managed. As many patients live a significant distance from the hospital, it is often not convenient for them to visit the hospital for follow-up appointments. In these cases, blood tests are conducted by external pathology services.
The time and costs associated with following up pathology services and communicating results to patients is significant, adding to the workload of clinical and nursing staff. Prior to the project, there were inefficiencies and delays in following up results, forwarding them to doctors and communicating them to patients. This led to delays in changing patients’ medication, which significantly increased their risk of morbidity and mortality.
A pre-implementation audit showed that medical staff were requesting an average of 47 files each day from nurses, for the purpose of reviewing external pathology results. This resulted in an average of 160 minutes per day spent by nurses and an average of three hours of overtime each day paid to medical staff to review pathology results. In addition, only 60% of external pathology results were reviewed within three days of the blood tests.
As a result of ongoing complaints from patients and patient advocacy groups, as well as overall dissatisfaction from clinical staff and increased costs associated with overtime paid to doctors, it was determined that improvements to following up and communicating pathology results was required.
Implementation
- A SOP for the management of external pathology results was developed.
- A simplified flowchart of the SOP was turned into a poster and displayed in clinical areas, to help staff understand and implement it in the Clinic.
- The SOP was added to the orientation of new doctors and nurses, to ensure they were aware of the process.
- Clear guidelines that outlined when to order pathology tests were developed, to reduce over-prescribing and improve staff efficiency.
- A dedicated area for reviewing patient files was created, to reduce the risk of files being misplaced and improve communication between doctors and nurses.
- A roster was implemented, providing doctors with dedicated time to review pathology results, so they were completed in a prompt and efficient manner.
- An information brochure was developed for patients, to explain the new process and educate them on the importance of regular blood tests.
- The patient database was updated to include a mobile phone number and email address, to improve communication with patients.
- A dedicated email address was created for the purpose of communicating pathology results, with both inbound and outbound messages stored on this account.
- Pathology results were consolidated, so the clinic no longer received results in different formats and at different times.
- A two-tier system of ‘urgent’ and ‘non-urgent’ blood tests was established.
- A logbook to manage the follow-up of pathology results was created, which will be used to audit results in the future.
- A phone script, email and SMS template was developed to standardise communication with patients. Patients received a phone call if they required a change in their treatment, while an email and SMS was sent if no change was required.
Project status
Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
Key dates
- Project start: June 2016
- Project Implementation: February 2017
- Project evaluation: June 2017
Implementation sites
Heart and Lung Clinic, St Vincent’s Hospital Sydney, SVHN
Partnerships
Clinical Excellence Commission Clinical Leadership Program
Evaluation
- A full evaluation will be undertaken in June 2017, with measurement of the following outcomes:
- patient satisfaction, measured by a survey
- staff satisfaction, measured by a survey
- number of results reviewed by doctors
- length of time from sending blood to pathology service to results received
- length of time from receiving results to communicating results to patient
- staff overtime costs and patterns.
- Once implemented and successful, the project will be rolled out across the entire Lung Transplant Unit.
Lessons learnt
- It’s important to gain input from everyone involved in the project.
- Change is difficult, particularly at the start of a project when a system has been in place for a long period of time. However, things often improve once the benefits are experienced first-hand.
- Holding frequent team meetings is crucial, to ensure momentum and morale is maintained.
- It’s important to keep things as simple as possible – once solutions are workshopped they can grow in complexity and become harder to achieve.
- It can be difficult to source historical data, particularly with systems that have not been set up with this in mind. With each solution, consideration was given to recording data for future auditing purposes.
Contact
Dr Mark Benzimra
Staff Specialist in Thoracic Medicine and Lung Transplantation
St Vincent’s Hospital Sydney
St Vincent’s Hospital Network
Phone: 02 8382 2337
mark.benzimra@svha.org.au
