Background With the demand for hospice care rising and staffing levels unable to increase to meet demand, it was agreed to explore implementing a Single Point of Access (SPA) (Hosking, Gibson. J Med Eng Technol. 2016, 40(5): 265–269) to help support the flow of referrals and ensure referrals go to the right service at the right time. The project is ongoing and has been split into phases, with phase one exploring referral registration pathways (Ewebank, Lamming, Cream, et al. Admin matters: the impact of NHS administration on patient care [Internet]; 2021 Jun 24) and improving the recorded number of referral outcomes.
Aim Re-designing the referral registration process to create a standardised method of inputting referrals and increase the number of recorded outcomes to 75%.
Methods Process mapping, sample audit of referrals and missing information completed. Redesign of registration template tested using the Model for Improvement (Langley, Moen, Nolan, et al. The improvement guide: a practical approach to enhancing organizational performance. 2009, 2nd ed). PDSA cycles used monitored the success of the new template. Introduction of a criteria check tool to record referral outcomes against service criteria. Baseline set as 0% recording of outcomes. Tool tested with one service using PDSA cycles to manage risk. Engagement with staff to use decision tool (Randall. Using communications approaches to spread improvement. The Health Foundation, 2015). Staggered approach used to onboard other services.
Results Clinical administration use one standardised method of registering patient information, increasing cross cover and reducing silo-working for annual leave and sickness where previously there would be a pause in referral registration. Reduction in paper (one team now 100% paperless at referral). Referral outcomes are now reported through SystmOne with a clear auditable journey. Clinical staff have increased control over flow of referrals and inappropriate referrals being declined at an earlier stage. Quantitative data is still being processed. Initial data shows 75% of recording referral outcomes is being achieved. The data will continue to be analysed and demonstrated through run charts.
Conclusion Following data results, to introduce a single point assessment into the registration pathway to further support the flow of referrals into services and create an online referrals portal for all future referrals into the hospice.
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