Clinical Immunology & Allergy Unit

 

Summary:

As at April 2014, there were approximately 900 patients in the follow-up pool receiving care from the STH Clinical Immunology & Allergy Unit (CIAU), which is run from the Northern General Hospital (NGH).  An average of around 36 referrals are received by the Unit each week, with around 45% of new patient attendances and 25% of follow-up patients being discharged from the service each week.  The Unit provides nurse led immunoglobulin clinics every Monday; 10 face to face Allergy Clinics per week; 2 nurse led telephone follow up clinics per week; 3 Immunology Clinics per week;3 Challenge clinics per month, with urgent challenges fitted in as extra; and desensitisation appointments 4 days per week to a variety of allergens.

Assessment:

Since October 2012, the Clinical Immunology and Allergy Team (clinical and non-clinical) have regularly met for one hour each week to discuss areas for potential improvement to benefit both the team and its patients and visitors.   As a result of carrying out a ‘5Ps assessment’, the initial data indicated:

  • Waiting times from referral to first appointment were too long as a result of capacity and demand mismatch
  • Inefficient patient flow during clinic resulting in clinics regularly overrunning and long patient waits
  • Bank holidays and seasonal pressures created huge variation in daily demands on the team, especially with regards to daycases
  • Considerable variation in the patient wait time for follow-up appointments depending on which doctor they were seeing
  • Inadequate effective communication process within the Unit and between community, primary and secondary care  
  • Patients found the new location of the CIAU difficult to find
  • Patients were often not aware of what they needed to bring to their appointment or how long their appointment could potentially take
  • High DNA rates, especially for Allergy follow-up patients
  • Significant increase in the number of referrals over the last few years
  • Productivity in the appropriate job roles decreased due to inefficient processes

 

Diagnosis:

The team used the data to identify four key improvement themes.  The Global Aims and several Specific Aims have been agreed, relating to the first four themes: 

  • Theme 1 ‘Capacity Planning/Clinic Rescheduling’ – “We aim to improve the patient experience and staff working environment in the Clinical Immunology & Allergy Unit (CIAU) at the Northern General Hospital”
  • Theme 2 ‘Team Working/Communication’ – “We aim to improve communication and integration between staff members in the CIAU”
  • Theme 3 ‘Patient Information’ – “We aim to improve communication with patients and the CIAU”
  • Theme 4 ‘Patient DNAs’ – “We aim to improve the Patient DNA rate in the CIAU” 

Treatment:

To date a number of significant improvements can be evidenced through collection of measurement data:

  • The patient follow-up DNA rate has reduced from 20.0% in July 2013 to 13.7% in February 2014
  • The new DNA rate has reduced from 15.6% in July 2013 to 8.2% in February 2014
  • Reduction in the wait time for a new immunology appointment from a maximum of 18 weeks in May 2013 to a maximum of 6 weeks in March 2014

 

 

 

  • Reduced variation between the different clinicians’ allergy follow-up slot availability from a maximum of 15 weeks in May 2013 to a maximum of 2 weeks in March 2014
  • Introduction of additional Allergy Clinic to see 4 new allergy  patients each week
  • Increased availability of follow-ups to enable patients to be seen when they need to be seen, due to a reduction in variation of follow-up slots between doctors through pooling of lists
  • Wednesday morning allergy clinics running to schedule, starting and finishing on time (subject to unpredictable patient reactions)
  • Introduction of ‘Handover Book’ for nurses
  • Established structure and process for effective daily handover briefings between doctors and nurses
  • Improved hospital signage for patients and visitors to locate the Unit more easily
  • New staff photo board in patient waiting area identifying all CIAU staff members
  • Use of daily whiteboard in patient waiting area to advise on clinics running, staff on duty, any potential delays in clinic etc
  • Establishment of new CIAU Website

Future Progress:

In 2014, the team plans to initially focus on:

  • Roll-out of Wednesday morning clinic rescheduling PDSA to all allergy clinics to improve the quality of patient and staff experience more widely
  • Further reduce the CIAU DNA rates
  • Improve the booking system for Monday daycases to reduce patient wait times in clinic, smooth patient flow and increase staff and patient satisfaction
  • Update content of patient letters/information for CIAU outpatient clinic and daycase patients

Share this:

View featured stories

imgimgimg imgimgimgimgimg