Authored by Christian Tam, Clinical Specialist Physiotherapist/CATS Manager at Southend Hospital, part of the Mid and South Essex Trust
Around four in five people on an NHS waiting list are waiting for an outpatients appointment, according to NHS England. And what’s more, analysis from the Institute for Fiscal Studies (IFS) revealed that although there have been signs of improvement in the past month when it comes to waiting lists, lists are unlikely to fall in 2023. Plus, the backlog is unlikely to be significantly tackled until mid-2024. That is, despite the NHS backlog being one of Rishi Sunak’s priorities for this year.
With seven million people stuck on waiting lists, but more than 7.5 million hospital appointments in England missed last year alone due to patients not showing, the NHS is facing some severe challenges.
As a clinician, I understand that the government expect us to overhaul our systems and reduce the number of no-shows, but this is no easy feat.
I work at Southend Hospital, part of the Mid And South Essex Trust, within the outpatients department – specifically managing the MSK department which consists of orthopaedics, physiotherapy, pain management and orthotics.
We’ve run a referral assessment service for the last six years, which has been very successful in reducing the number of referrals unnecessarily being sent to Orthopaedic or Rheumatology consultants. But we’ve also always felt that we can evolve and improve this process if we were to be able to look into information and data regarding the patients’ symptoms. Of course, doing this manually though would have been an incredibly laborious and time intensive task.
This means that we’ve been facing a much bigger challenge in that more often than not, individuals are regularly referred to the wrong department, which means a re-referral and second follow up appointment is needed. Not only has this been further adding to our queues of patients waiting to be seen, but, seeing the wrong clinician at the initial appointment phase adds to confusion for patients and in some instances, further delay to their problems.
Incorrect referrals have made it incredibly challenging for our team to correctly resource departments with the right number of staff, and make it much harder for us to identify red flag cases to prevent life changing problems. This is why we turned to eConsult’s outpatients technology last year, and we’re already reaping the benefits.
Implementing digital technology
We decided to implement eConsult for outpatients – a specialist history take, triage and remote consultation platform – which has been designed specifically for outpatients departments. The technology has clinically designed question sets with built in intelligence and flagging that respond to previous answers, and are sent to patients before their outpatient appointment and therefore save the patient and the department time.
We’ve found that by collecting information from patients upfront, unnecessary or inappropriate appointments can be removed and routed elsewhere.
A great example of the positive impact we’ve seen so far from this technology is in ensuring patients with spinal conditions were routed to the right clinician, at the right time. So far, we’ve been able to divert 66% of spinal referrals from orthopaedics to the physiotherapy department as of February 2023, which has not only allowed us to correctly resource the physio department, but it’s also supported in reducing the backlog for orthopaedics.
And it’s not just spinal patients reaping the benefits. 15% of patients with knee injuries were diverted from orthopaedics to physiotherapy, and the diverted number of hip patients currently sits at 23%. Though these results are lower, even a 1% diverted result would be a positive step in the right direction.
There are two benefits to this redirection of patients. The first, is that patients who can be treated by a physiotherapist are seen much faster, without unnecessary appointments with specialist surgeons blocking their direct route to care. The second, is that those who for example perhaps display more emergency issues, can be seen by the correct orthopaedic clinician sooner.
Identifying ‘red flags’
The NHS has been struggling to increase the number of people it is treating from its waiting lists each month due to ongoing pressures from Covid-19. And the backlog is having potentially life-threatening and debilitating impacts on patients who find themselves with serious conditions, but right at the bottom of the waiting list based on the order in which their referral to the department was received.
Working with eConsult for outpatients, we’re now in a much better position to identify patients with what we call ‘red flag’ conditions. This is, patients with life-threatening conditions who simply can’t risk queues and added steps before seeking emergency care.
To spot these ‘red flag’ patients, we have implemented an electronic triage process which asks a series of clinically designed questions to gather the right information on the patient’s symptoms which isn’t always captured during the referral stage.
This has and will continue to enhance the patient safety and experience in numerous ways. Patients will be seen in order of clinical need, and have more control over their appointments, allowing them to pre-book test and appointments with relevant specialists by providing information beforehand. Clinicians can understand patients’ situations ahead of any appointment, streamlining the referral process.
It will also help the NHS lower the number of appointments required. Not only is this preferable to patients, but it will allow staff to allocate their time and resources more accurately. Nurses will be able to triage more efficiently, and altogether, the process will eliminate unnecessary outpatient appointments and direct patients to where they need to be.
Digitisation of triaging
Particularly in a post-pandemic world, it’s impossible for healthcare practices to manually handle all referrals that come through and give adequate time and effort to each patient referral. The eConsult Specialist triage system consolidates all of the issues that NHS hospitals have been facing with outpatient referrals and streamlines the processes.
Adopting a digital triaging system gives patients control over their initial appointments, and gives time back to nurses spent on triage. And it’s an investment in future time – less appointments will be necessary if the right referral call is made from day one. The answer to composing this process is expanding digital software beyond just maintaining patient records, and allowing it to be an active part in the triage process. Patients, nurses and specialists will all benefit from an accurate and reliable system of outpatient care.
Please visit https://econsult.net/ to find out more.
