1 Level : Practitioner Day 1

Outpatient Clinic Summary of Demand & Activity DataGeneral Clinics - Tayside

2 Level : Practitioner Day 1

NHS TaysideOrganisational Context

DEALING WITH THE 5% SPENDING THE 95% BETTER

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Summary Outpatient Clinics

Summary

• This pack contains information on the demand, capacity and activity for the clinics being analysed.

Data Sources

• The data used has been collected from TOPAS.• TOPAS includes referrals from all sources (electronic, paper, consultant, etc)• All clinical activity new and return is recorded on TOPAS.• A years worth of data has been analysed from (wk 31 2009 – wk 30 2010)

Information Provided

• Demand is new patient referrals into the service (number of referrals on a weekly basis).• Activity is the actual number of new and return patients seen on a clinic or set of clinics.• Optimum new capacity is calculated using 80% of the weekly variation plus the minimum.• Capacity has been collected from the current template capacity and number of clinics.

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Summary of General Consultant Clinics at Ninewells (week 31 2009 to week 30 2010)

DCAQ New Return Notes

Demand Total = 4,311Per Week Average = 81Min = 27Max = 127

New:Review ratio = 1 : 0.7 Based on 53 weeks of Demand for week 31 2009 to week 30 2010

Optimum capacity Optimum capacity = 101(Outliers removed 122, 124, 127)Based on 80% of variation plus the minimum

Capacity based on actual new patients seen and current new: review ratio = 2,647 per year

Current Clinics (see clinic code sheet for more detail)

12 clinics currently template10 x weekly1 x fortnightly1 x varies

11 clinics currently template9 x weekly1 x fortnightly1 x varies

A7SI7N – new clinic only

Current Capacity New = 74 Return = 61 A7ADDN – has a template capacity which varies for both new and return clinics

Clinic Template Variation Variation new templates = 3 to 12 Variation return templates = 2 - 16

Activity per week(also details frequency of clinics held)

Total = 3,782Average = 71Min = 22Max = 116DNA = 455 (10.7%)

Total = 2,689Average = 51Min = 10Max = 69DNA = 475 (15%)

No activity showing for clinic code A7RH0N (demand data only) for the time period 31 2009 – 30 2010

Current & Old Old Clinic Codes

A7AAF4N, AFAAF5N, AFAAF7N, A7AB4N, A7ABRY5N, A7ADDN, A7CG1N, A7GA4N, A7JF6N, A7RHON, A7SI7N, A7RD9N, A7AB3N (no longer runs), A7CA1N (old code), A7SPR5N (old code), A7SR4N (old code), A7SD9N (old code), A7SR9N (old code)

Excludes Reg Clinics and A7SR6N (6N/18R)

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Demand (referrals) General Consultant Clinics at Ninewells (Week 31 2009 to Week 30 2010)

Insert Total New Patient Demand Graph for Group for Clinics

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New Activity General Consultant Clinics at Ninewells (week 31 2009 to week 30 2010)

Insert Total New Activity Graph for Group for Clinics

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Return Activity General Consultant Clinics at Ninewells (week 31 2009 to week 30 2010)

Insert Total New Activity Graph for Group for Clinics

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Example - New Activity General Clinic at Ninewells (week 31 2009 to week 30 2010)

Insert Total New Activity Graph for Group for Clinics

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Example - Return Activity General Clinic at Ninewells (week 31 2009 to week 30 2010)

Insert Total New Activity Graph for Group for Clinics

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Example - New Activity General Clinic at Ninewells (week 31 2009 to week 30 2010)

Insert Total New Activity Graph for Group for Clinics

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Example - Return Activity General Clinic at Ninewells (week 31 2009 to week 30 2010)

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STEPS TO BETTER HEALTHCARE Referral & Outpatient Programme

Clinic CalculatorClinic Calculator

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STEPS TO BETTER HEALTHCARE Referral & Outpatient Programme

Managing Demand & Capacity

• Understand Capacity & Demand• Reduce variation in referral patterns

• Are there effective referral protocols for referrers?• Do they include pre-referral diagnostics?

• Can the vetting process be improved to reduce demand• Is advice provided as an alternative to Outpatient Appointment?

• Understand the new to review ratio• Can the new to review ratio be improved?• Have you considered alternative types of follow up if it is required?• Can specialist nurses see return patients (new patients in some cases)?

• Are consultants working as a team to ensure OP clinics are delivered more consistently?• Are clinic working hours maximised to see a higher number of patients?

Managing Demand & Capacity

• Understand Capacity & Demand• Reduce variation in referral patterns

• Are there effective referral protocols for referrers?• Do they include pre-referral diagnostics?

• Can the vetting process be improved to reduce demand• Is advice provided as an alternative to Outpatient Appointment?

• Understand the new to review ratio• Can the new to review ratio be improved?• Have you considered alternative types of follow up if it is required?• Can specialist nurses see return patients (new patients in some cases)?

• Are consultants working as a team to ensure OP clinics are delivered more consistently?• Are clinic working hours maximised to see a higher number of patients?

Reducing Waste & Variation

• Can pre diagnostic test make a more informed first outpatient appointments and reduce the need for return appointments?• Make best use of clinical facilities and reduce clinical travel time• Can one stop clinics prevent the need for return patients?• Can virtual clinics be held?• Are all return appointment necessary?• What is your DNA rate – how can you improve it?• Are clinic start and finish times standardised?• Can clinic templates be standardised to reflect best practice and reduce variation?• Could the booking processes be improved to reduce DNA’s?

Reducing Waste & Variation

• Can pre diagnostic test make a more informed first outpatient appointments and reduce the need for return appointments?• Make best use of clinical facilities and reduce clinical travel time• Can one stop clinics prevent the need for return patients?• Can virtual clinics be held?• Are all return appointment necessary?• What is your DNA rate – how can you improve it?• Are clinic start and finish times standardised?• Can clinic templates be standardised to reflect best practice and reduce variation?• Could the booking processes be improved to reduce DNA’s?

Improving Flow

• Can patients be pooled for general clinics and seen on a first come first served basis to prevent queues for individual consultants?• How is the mix of new and review patients scheduled into clinic templates to improve flow• How are any diagnostics scheduled into the clinic template to improve flow?

Improving Flow

• Can patients be pooled for general clinics and seen on a first come first served basis to prevent queues for individual consultants?• How is the mix of new and review patients scheduled into clinic templates to improve flow• How are any diagnostics scheduled into the clinic template to improve flow?

Outpatient Key Improvements

Outpatient Key Improvements