A&C Role A&C Role DevelopmentDevelopment

Yorkhill’s MRI ServiceYorkhill’s MRI Service

Lorraine Peebles, SIM, Diagnostics, NHSGGC 31 Mar 10

Once Upon a Time……Once Upon a Time……

Concern about MRI department’s ability to transform its resources effectively to

reduce waiting times for patients

MRI PATIENT JOURNEY

MRI REFERRAL PATHWAY

The Way We Were!The Way We Were!Roles and responsibilities within MRI department blurred –

Radiographers doing A&C tasks (booking beds, theatre time, Anaesthetists/OP appts and cancelling appts)

Imaging Assistant duties inappropriate (mostly clerical)

MRI reception area not staffed and Telephones on answering machine

Cancelled Appointments not being re-used – capacity being wasted (GA appts)

Referral demand not being managed – eg, no emergency slots identified

Patient clinical and safety information from Referrers often inadequate

No agreed Appointment templates

Data and information being captured in two separate IT systems

Theatre staff, Ward staff and Imaging staff unsure of their responsibilities in relation to input of data

No joined up working between MRI, Anaesthetics and Day Care

Prospective anaesthetic rotas sometimes unavailable

1. Seamless, high quality MRI patient journey for inpatients, day cases and outpatients

2. Increased throughput and utilization of GA MRI sessions by managing the referral pathway and associated data effectively

Over-arching ObjectivesOver-arching Objectives

Tool used : RIETool used : RIE

• Rapid Improvement Events are part of the Lean 'toolkit' and provide a mechanism for making radical changes to current processes and activities (patient pathways) within very short timescales.

"The power of RIEs comes from the combined talents of cross functional teams being focused on achieving specific goals in relation to bottom line, operational

improvements" - Andrew Scotchmar, Data Analyst, East Lancashire

Health Economy

Selling the RIE Tool!Selling the RIE Tool!

• Why we needed to change

• What did we need to change

• Baseline of the current performance and trajectory of where we think this new model would take us – 4 weeks!

• High profile executive leadership and management buy-in

• Key Stakeholder buy-in

• Champions within the MRI team to drive the transformation

NHS Institute for Innovation and NHS Institute for Innovation and ImprovementImprovement

“Optimising roles along an agreed pathway of care leads to significant improvements for staff and patients in key areas”:

Role Development/DesignRole Development/Design

Reducing delays in patient journeyReduction in waiting timesImprove patient servicesTackle staff shortagesIncrease job satisfaction by developing and amending rolesBenefit entire Health Care Team – Support Workers to Medical WorkforceImprove quality and flow of patient journey To attract and retain an effective workforce

ReferralAccess

Managing Demand

AcquisitionReporting/Verification

Report toSpecialty Referrer

Key Components which together make up the Key Components which together make up the Integrated Patient JourneyIntegrated Patient Journey

Specialty Referral

Approach to RIEApproach to RIE

SEAMLESS

Increased throughput and utilisation of MRI

Sessions

Areas for ImprovementAreas for Improvement

• Referral access

• Vetting

• Acquisition

• Reporting

• Data management

MRI REFERRAL COORDINATOR

to provide continuity & work closely with Supt Radiographer

A&CA&C

No MRI A&C input

MRI A&C duties distributed over main office

HCSWHCSW

Appting patients on PC and in duplicate paper diary

Phoning patients

Posting letters and sending out checklists

Logging of referrals

Patient demographics inadequately checked and IT system not updated

Reception duties

Answering phone

GA NurseGA Nurse

Phoning Wards for patients

Portering duties

Dealing with anxious parents and less time with patient

Reception duties

Answering telephone with appt changes

Ordering supplies

RadiographerRadiographer

Arranging manual diary – managing waiting list

Bed/Theatre Booking

Chasing up referrers re complex cases/additional info

Supplies Ordering

Monitoring vetting

Safety Checklists

Reception duties

Answering phone

Scanning patients

RadiologistRadiologist

Vetting being done on an ad-hoc basis

Constant interruptionsCURRENT SPLIT CURRENT SPLIT

OF DUTIES RELATING OF DUTIES RELATING

TO THE TO THE

REFERRAL PATHWAY REFERRAL PATHWAY

AND AND

PATIENT JOURNEYPATIENT JOURNEY

REFERRAL COORDINATOR REFERRAL COORDINATOR

Managing waiting list

Cancelling / reappointing

Monitoring vetting

Chasing Referrers re complex cases/additional info

Bed/Theatre Booking

Answering/filtering phone calls

Phoning Wards for patients

Logging & appointing patients on PC

Appointing patients on PC

Phoning patients with appointment and carrying out Safety Checklist

Checking patient demographics

Posting letters and sending out checklists

Reception duties

HCSW

More time with patients and carers

Assisting with transport of patients

Ordering of supplies

Assisting Phoning Wards for patients

GA Nurse

Dealing with

Anxious parents/

patients

Administering contrast

Available during scanning

Radiographer

Scanning patients

Radiologist

Vetting (monitored by Referral Coordinator)

Telephone calls filtered by Referral Coordinator

PROPOSED SPLIT OFPROPOSED SPLIT OF

DUTIES RELATING DUTIES RELATING

TO THE REFERRALTO THE REFERRAL

PATHWAY AND PATHWAY AND

PATIENT JOURNEYPATIENT JOURNEY

Action ListAction List

• Business Case for Referral Coordinator

• Business Case for additional GA Nurse

• Developed new referral form

• Developed new referral access criteria

• Developed new referral management process

• Developed new inpatient journey from ward

to MRI

• Worked with stakeholders to promote data input

Current Landscape – Where are we now?Current Landscape – Where are we now?

Safe, sustainable, seamless

patient journey to MRI and back

Maximise MRI scanner

utilisation

4 week wait from referral to report

48 hours max wait

for all urgent IP referrals

Reduce DNA rates

to < 4% and short notice

cancellations

Improve MRI staff morale

and job satisfaction

Improve on current

high quality of service

to Referrers

Clear process &responsibilities

for Managing referral

pathway

Appropriate allocation

of MRI duties &

responsibilities

Joined-up working between key

stakeholders in patient journey

Clear process &responsibilities

defined for data management

Referral Coordinator

A&C Role A&C Role DevelopmentDevelopment

Yorkhill’s MRI ServiceYorkhill’s MRI Service

Lorraine Peebles, SIM, Diagnostics, NHSGGC 31 Mar 10