Abstract
The aim of the Integrated Care Programme for Older Persons is to develop and implement integrated services and pathways for older people with complex health and social care needs, shifting the delivery of care away from acute hospitals towards community based, planned and coordinated care.
In implementation we set about developing new pathways of care into the following; Rapid Access, Falls and Frailty, Cognitive and Movement Disorder. We developed rapid decision support mechanisms, single point of access to facilitate rapid acceptance and processing of referrals.
It was evident that the administration team and processes have the potential to improve patient experience, reduce inequalities, promote better care – and contribute to better working environment for all staff.
A department audit risk assessment and staff feedback sessions were conducted. The findings of this highlighted the need to develop a single wait list management guideline document. Moving away from task processes to teams managing pathways. This project involved cooperation from the admin, clinical and management and PMO staff to co-design processes. This document is also transferable across all new hubs in development.
Key priorities to implement this change across the Clerical and Clinical team:
- Clear Governance and Reporting Structures
Setting up a local working group incorporating representatives from operational and clinical management, clerical, nursing and the MDT team. Agree the new way of working and provide a step by step guideline document which informs all processes for referral and management of referrals in the department.
- Develop Standard Operating Procedures (SOPs) in line with the national guidelines
This document was developed in line with the national guideline document- National Outpatient Waiting List Management Protocol and adapted for the service.
- Quality Reviewed and Assured Data and Information
Conducting regular hospital level data validation to include lapsed appointments, duplicates, CNAs and DNAs, etc.
The document has been reviewed by the ICT working group and is in line with the national guidelines and CUH procedures.
Achievements/Impact on staff.
- An enhanced and standardised referral management system, providing decision support and enhanced access to appropriate healthcare.
The service operates in the busiest hub in the program ~2500 new referrals with the highest percentage of same/next day reviews
- Improved and agreed patient administration systems guideline document.
- Appropriate routing of referrals to the best location for management of the various level of triage acuity, with telemedicine and virtual clinic solutions offering increased efficiency and flexibility for service providers and service-users.
- An ambulatory service where the most acute conditions are managed in an acute environment, with structures in place to enable less acute conditions to be managed through ICPOP and Outreach Service in the community or in the patient’s home.
- Development of a set of standardised outpatient referral pathways that cross the care continuum.
- Enhanced, clinically-approved referral pathways enabling appropriate access, from prevention to treatment, within recommended timeframes for people in need of healthcare.
- Agreed clinical prioritisation with clinically recommended timeframes (CRTs).
- A formal audit process addressing process and clinical outcomes.