respiratory physiology diagnostics north east glasgow
DESCRIPTION
Respiratory Physiology Diagnostics North East Glasgow. Roger Carter Consultant Clinical Scientist. The service we provide :. The North East Glasgow Hospitals provide lung function service to a local population of 350,000 - PowerPoint PPT PresentationTRANSCRIPT
Respiratory Physiology Diagnostics
North East GlasgowRoger Carter
Consultant Clinical Scientist
The service we provide The North East Glasgow Hospitals provide lung function service to a local population of 350000A wide range of diagnostic respiratory physiology services are delivered from two dedicated respiratoryphysiology laboratories based at Glasgow Royal Infirmary and Stobhill Hospital In total 42 respiratory sleep
investigations have been coded
The following investigations are offered at both sites bull Spirometry bull Bronchodilator Assessmentbull Lung Volumes by Body Plethysmography bull Transfer Factor and componentsbull Ear lobe capillary blood gases bull LTOT Assessmentbull Ambulatory Oxygen Assessmentbull Flight Assessmentbull Bronchial Reactivitybull Cardio-Pulmonary Exercise Testingbull Surgical Risk Assessmentbull Nebuliser Assessment bull Nebuliser Exchange Servicebull Outreach Spirometry (GP Flow Volume Loops) bull Respiratory Muscle Assessmentbull Respiratory Drive bull Sniff Pressures
Volume Time Curves
Time (Seconds)
Vol
ume
(Lit
res)FEV1
Normal
Obstructive
Severe Obstruction
Restrictive
Flow Volume Loops - Emphysema
SYMPTOMScoughcough
sputumsputum
dyspneadyspnea
EXPOSURE TO RISKFACTORS
tobaccotobacco
occupationoccupation
indooroutdoor pollutionindooroutdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
The service we provide The North East Glasgow Hospitals provide lung function service to a local population of 350000A wide range of diagnostic respiratory physiology services are delivered from two dedicated respiratoryphysiology laboratories based at Glasgow Royal Infirmary and Stobhill Hospital In total 42 respiratory sleep
investigations have been coded
The following investigations are offered at both sites bull Spirometry bull Bronchodilator Assessmentbull Lung Volumes by Body Plethysmography bull Transfer Factor and componentsbull Ear lobe capillary blood gases bull LTOT Assessmentbull Ambulatory Oxygen Assessmentbull Flight Assessmentbull Bronchial Reactivitybull Cardio-Pulmonary Exercise Testingbull Surgical Risk Assessmentbull Nebuliser Assessment bull Nebuliser Exchange Servicebull Outreach Spirometry (GP Flow Volume Loops) bull Respiratory Muscle Assessmentbull Respiratory Drive bull Sniff Pressures
Volume Time Curves
Time (Seconds)
Vol
ume
(Lit
res)FEV1
Normal
Obstructive
Severe Obstruction
Restrictive
Flow Volume Loops - Emphysema
SYMPTOMScoughcough
sputumsputum
dyspneadyspnea
EXPOSURE TO RISKFACTORS
tobaccotobacco
occupationoccupation
indooroutdoor pollutionindooroutdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Volume Time Curves
Time (Seconds)
Vol
ume
(Lit
res)FEV1
Normal
Obstructive
Severe Obstruction
Restrictive
Flow Volume Loops - Emphysema
SYMPTOMScoughcough
sputumsputum
dyspneadyspnea
EXPOSURE TO RISKFACTORS
tobaccotobacco
occupationoccupation
indooroutdoor pollutionindooroutdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Flow Volume Loops - Emphysema
SYMPTOMScoughcough
sputumsputum
dyspneadyspnea
EXPOSURE TO RISKFACTORS
tobaccotobacco
occupationoccupation
indooroutdoor pollutionindooroutdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
SYMPTOMScoughcough
sputumsputum
dyspneadyspnea
EXPOSURE TO RISKFACTORS
tobaccotobacco
occupationoccupation
indooroutdoor pollutionindooroutdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
NICE COPD 2004 Severity of obstructionFEV1FVC lt70
bull FEV1 lt80 gt=50 Predicted
bull Mild airflow obstruction
bull FEV1 lt49 gt=30 Predicted
bull Moderate airflow obstruction
bull FEV1 lt30 Predicted
bull Severe airflow obstruction
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Diagnosis Asthma
bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them
bull If high probability - trial of treatment
bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Intermediate Probability of Asthma
bull In view of lifelong treatment seek objective evidence of airflow obstruction
bull Spirometry is preferred over peak flow at diagnosis
bull Caveat - normal spirometry if asymptomatic does not exclude asthma
bull Peak flow diaries demonstrating airflow variability are helpful
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Management of stable COPD
100
80
60
40
20
Healthy population
Smokers coughLittle or no dyspnoeaNo abnormal signs
Exertional dyspnoeaCough amp sputumSome abnormal signs
Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough
Death
Wo
rsen
ing
lu
ng
fu
nct
ion
FE
V1 a
s
pre
dic
ted
Increasing investigation and treatment
Smoking cessation
Antibiotics for acute infections
Trial Symptomatic bronchodilator therapy
Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations
Influenza vaccinationPulmonary rehabilitation
Assessment for LTOT
Symptoms
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Waiting Times Spirometry
bull 2007ndash Average Waiting Time 9 weeks
ndash Longest Waiting Time 12 weeks
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Make a difference by
bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways
bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant
technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS
system bull These are at present appointed by clinical physiologists bull This has enabled
ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics
ndash 1048707 Record accurate data on patient administration system
bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots
bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
What benefits did we achieve
bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two
laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request
bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)
bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list
policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)
bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
How we measured the achievement
bull Data analysis from PAS bull Reduced waiting times for new patients from 9
weeks to approximately 4 weeks bull Increased one-stop clinics due to better time
management by physiologists bull Reduced waiting times were observed in the
monthly returns bull Tables indicating the waiting time trends and
including activity referral and patient DNAs
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
Wait
Days
Weeks
0-7
1
8-14
2
15-21
3
22-28
4
29-35
5
36-42
6
43-49
7
50-56
8
57-63
9
64-70
10
71-77
11
78-84
12
85-91
13
gt92
gt13
NOV
2008
22 25 17 17 78 231 126 63 23 10 9 5
NOV
2009
118
92 155 256 8 2
FEB
2010
59 53 153 267 102 1
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS
system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this
booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation
bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency
bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-
Further Developmentbull A dedicated administrator appointment to manage
patient bookings ndash Freeing of clinical physiologist time presently spent on doing
routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times
bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail
bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT
- Respiratory Physiology Diagnostics North East Glasgow
- The service we provide
- Volume Time Curves
- Flow Volume Loops - Emphysema
- Slide 5
- NICE COPD 2004 Severity of obstruction FEV1FVC lt70
- Diagnosis Asthma
- Intermediate Probability of Asthma
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Waiting Times Spirometry
- Make a difference by
- Making a difference what we did
- What benefits did we achieve
- How we measured the achievement
- Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
- What challenges did we face in making this idea work for us
- Further Development
-