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Improving Timely Access and Attendance in Outpatients

Project Added:
9 December 2015
Last updated:
18 December 2015

Improving Timely Access and Attendance in Outpatients

Summary

This project implemented processes to improve the availability of appointments, including a referral triage system, appointment reminders and a new non-attendance policy.

View a poster of this project from the Centre for Healthcare Redesign graduation, 2014.

Aim

To increase the percentage of acute physiotherapy outpatients who are seen in less than 14 days from 60% to more than 80% and decrease the percentage of patients who don’t attend appointments, from 15% to less than 11%.

Benefits

  • Improves resource allocation and provides staff with dedicated time to complete administration tasks.
  • Encourages patients to take responsibility for their healthcare and attend appointments.
  • Reduces lost revenue due to high ‘Did Not Attend’ (DNA) rates.
  • Delivers services more efficiently and effectively, to improve patient outcomes.
  • Improves communication between the patient and outpatient clinic.

Background

In 2012, 342 (40%) acutely referred physiotherapy patients at Westmead Hospital breached the 14-day access time set as a key performance indicator. Delayed access to physiotherapy can lead to poor post-operative outcomes, increased disability and prolonged rehabilitation. In this same period, 991 (15%) booked appointments had patients that DNA. This represented $200,000 in potential lost funding annually.

These results, combined with the increased demand for acute outpatient services without any foreseeable increase in resources, indicated a need to redesign the delivery of outpatient physiotherapy services at Westmead Hospital.

Implementation

  • Consultation took place with 36 physiotherapy staff, 10 patients and two carers to identify key issues with current process. These included:
    • no dedicated time for staff to make bookings
    • difficulty with the clinic contacting patients and vice versa
    • no free physiotherapy timeslots available for new patient appointments
    • patients forgetting to attend appointments, resulting in high DNA rates.
  • As a result of this consultation process, the following solutions were put in place:
    • a triage system for referrals was introduced, where referrals are prioritised as acute, 30 or 60 minutes in length
    • administration time was set aside for staff to perform acute bookings
    • a voicemail system was introduced so patients have a way to contact the clinic
    • dedicated physiotherapy time was allocated to new or acute cases to ensure more timely access for high-priority patients
    • an SMS and automatic telephone reminder system was introduced to remind patients of upcoming appointments
    • a robust non-attendance policy was introduced to encourage patients to inform the clinic in advance when they can’t attend an appointment.

Key dates

  • Project start: April 2013
  • Project finish: February 2014

Project status

  • Sustained - The project has been implemented, is sustained in standard business.

Implementation site

  • Westmead Hospital Physiotherapy Outpatients Clinic

Partnership

  • Centre for Healthcare Redesign

Results

  • DNA rates showed significant improvement. In 2013 we had 1080 appointments lost to DNA which equated to 13% of all appointments. SMS reminders were implemented in October 2013. In 2014 we had 894 appointments lost to DNA which equated to 10% of all appointments. This represents a 22% improvement in patient attendance.
  • The number of acute patients seen within 14 days continued to fluctuate from the project start in April 2013 (59%), project implementation in August 2013 (67%) and project completion in February 2014 (81%). It did not consistently achieve the goal of more than 80%.

Lessons Learnt

  • Further redesign is now being considered, including the use of a student workforce to support administration duties and further changes to the appointment structure.
  • It is expected that DNA rates will continue to improve, but more dramatic changes may be required to achieve timely access for patients.
  • The project was implemented at a time of reduced staffing due to school holidays and annual leave, which affected the ability to consistently implement changes.

Further Reading

  • Greensmith, S. Physiotherapy Outpatient Efficiency: a project that reduced DNAs by 47.7%. United Kingdom: NHS Foundation Trust; 2013.
  • Hasvold PE, Wootton R. Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. Journal of Telemedicine Telecare 2011; 17: 358-364.
  • Liew SM, Tong SF, Lee VKM et al. Text messaging reminders to reduce non-attendance in chronic disease follow-up: a clinical trial. British Journal of General Practice 2009; 59: 916-920.
  • NHS Institute for Innovation and Improvement. Improving Patient Flow in the NHS: Case studies on reducing delays. United Kingdom: Ealing Hospitals NHS Trust; 2008.
  • NHS Institute for Innovation and Improvement. DNAs – Reducing Did Not Attends. United Kingdom: Derby Hospitals NHS Foundation Trust; 2008.
  • Price H, Waters AM, Mighty D et al. Texting appointment reminders reduces 'Did not Attend' rates, is popular with patients and is cost-effective. International Journal of STD & AIDS 2009; 20: 142-144.
  • Taylor NF, Bottrell J, Lawler K, Benjamin D. Mobile telephone short message service reminders can reduce nonattendance in physical therapy outpatient clinics: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2010; 93: 21-26.

Contact

Caleb TehPosition: Physiotherapist
Westmead Hospital Physiotherapy Department
Western Sydney Local Health District
Phone: 0407 387 188
caleb.teh@health.nsw.gov.au

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