Clinical Immunology & Allergy Unit



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.


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



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” 


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

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