Outpatients Improvement Case Studies

In arthritis patients, the longer inflammation continues, the greater the degree of functional impairment. The Directorate was unable to meet NICE Quality standards, in particular starting treatment within 6-8 weeks. Routine patients were waiting... for more information
In Cardiff and Vale University Health Board patients with suspected prostate cancer frequently experienced delay in diagnosis and treatment. A multi-disciplinary team developed a new pathway aimed at decreasing the waiting time from referral to... for more information
Cardiff and Vale University Health Board focussed on Age-related Macular Degeneration (AMD) to improve the pathway and facilitate discharge. The Pilot initially focused on fast tracking patients from the current pathway to the new pathway using... for more information
Chronic Lymphocytic Leukaemia is a haematological disorder usually identified on routine blood test. It often does not require treatment for a prolonged period, if at all. With the increasing use of blood tests as a diagnostic aid and an aging... for more information
Cardiff and Vale University Health Board had no formal discharge process for patients with Age-related Macular Degeneration (AMD) and the service was reaching breaking point. A new AMD Pathway was developed, including a Discharge Policy and Process; ... for more information
Historically, the only route available for GPs to refer non urgent patients to a cardiologist at Cardiff and Vale University Health Board was by referral to a consultant cardiologist outpatient clinic. Through a growing recognition that the status... for more information
The Primary Care workforce in North Wales is under severe pressure with insufficient General Practitioners. This initiative explores the effectiveness of Advanced Physiotherapy Practitioners (APP) clinically assessing patients with musculoskeletal... for more information
Betsi Cadwaladr University Health Board (BCUHB) is geographically the largest health organisation in Wales, providing services for a population of over 670,000 people with around 1.1 million outpatient appointments scheduled each year. Last year... for more information
Cardiff and Vale University Health Board was experiencing high rates of missed appointments - ‘did not attends’ (DNA), compared to peer comparators and underutilised outpatient clinics. Text messages were introduced to remind patients of their... for more information
Within the tertiary paediatric cardiology service there were 147 patients with a missed target date for their follow up appointment. This wait was averaging 41 weeks but ranging from 1 week to just under 2 years. This represented a significant... for more information
Historically Podiatry has used a system of providing patients their next appointment at the time of treatment resulting in clinics being booked up to 3 months in advance, a reduction in flexibility of available appointments to meet unexpected or... for more information
Morriston Hospital Appointment Booking Centre telephone lines were identified as an area in need of improvement due to lack of flexibility and increased patient complaints. The centre has the capacity to receive in excess of 12,000 calls per month.... for more information
Following a process-mapping exercise, we found that the follow-up patient waiting list was inaccurate due to a large number of clerical errors. Problems were identified with the inputting of information into the Welsh Patient Administration System... for more information
An increasing numbers of out-patient referrals were leading to long waiting lists for a routine haematology out-patient appointment. Many of these referrals were for minor abnormalities of blood counts, which had resolved by the time the patient was ... for more information
Rapid open access to Sexual Health Services is recommended for sexually transmitted infection (STI) testing and treatment. Whilst most individuals may require a full sexual history and clinical examination, it may be appropriate to offer a self... for more information
Following consultation with participants it was identified that people declined attendance at face to face groups owing to limitations by symptoms, logistics of travel or difficulty taking time off work. This information coupled with a need to... for more information
Cardiff and Vale University Health Board delivers about 135,000 new appointments each year. Endeavours to sustain a Partial Booking model had previously failed. Resultantly, practice was inconsistent and the appointment notification period was often ... for more information
Significant pressures in Aneurin Bevan University Health Board gynaecology department were creating challenges with waiting times for outpatient appointments. Improvement work was needed as higher than average Gynaecology referrals were being... for more information
With a vast increase in the amount of drugs available to actively manage multiple sclerosis (MS) and associated symptoms, additional clinical capacity is required to actively monitor patients, compounding demand for follow-up. A ‘see on symptoms’... for more information
Irritable bowel syndrome (IBS) affects 15% of the UK population. Historically, patients have been given basic dietary advice in secondary care which for many is ineffective. Patients are often prescribed medication or referred for invasive... for more information
Aneurin Bevan University Health Board has, in recent years, used a single booking centre for all outpatient appointments. That single centre was developed on the basis of improving efficiency. A review of the Centre found that the anticipated... for more information
There was an increasing number of patients on the Ear Nose and Throat (ENT) waiting list with impacted wax who were unable to progress to audiological assessment for hearing aids. The aim of the improvement was to reduce ENT waiting list, engage... for more information
A high volume of patients are referred to the oral surgery service in Cwm Taf University Health Board for dental extractions. The majority of these procedures are classified as minor oral surgery (MOS). Despite creating additional capacity in... for more information
The Health Board makes over 360,000 patient contacts each year. The majority of this has always been by letter, inviting patients to contact us, and then by telephone. This new text reminder service has been developed in order to modernise the... for more information
Endometrial cancer is the commonest female genital tract cancer in the developed world with almost 4000 cases per annum in England and Wales. At Wrexham Maelor hospital, an average of 30 referrals each month are received. These are triaged as... for more information
In Cardiff and Vale University Health Board (CVUHB) all specialties were experiencing a yearly increase in GP referrals into secondary care. All GP Practices have access to the Welsh Clinical Communications Gateway, however multiple methods of... for more information
Audiology at Abertawe Bro Morgannwg University Health Board (ABMUHB) is piloting the introduction of a Primary Care Audiology Service. It is consistent with the Welsh Government’s strategy to increase the number of services provided in the community ... for more information
Traditional diabetes services have relied on primary care referring to secondary care clinics for advice. This fragments care, incurs long delays due to waiting times to be seen results in duplication of work. Each of the 69 GP practices in the... for more information
Currently the time children have to wait for an assessment by Occupational Therapy (OT) exceeds the Welsh Government guideline of 14 weeks. An Improving Quality Together (IQT) Project introduced a streamlined central triage process to address this... for more information
Cardiff and Vale University Health Board set out to reduce demand on specialist services and meet the needs of primay care through the provision of secure communication for dialogue between primary and secondary care to obtain specialty ‘advice’ for ... for more information
In 2013 a North Wales consultation identified two factors from stakeholders; • Video Conferencing (VC) would be an acceptable alternative to attending a District General Hospital (DGH) for an outpatient appointment. • Local services should be... for more information
Historically patients with Low Back Pain (LBP) were referred to a variety of secondary care services with no objective referral criteria, no generic outcome measures and with some patients referred simultaneously to multiple services. Patients often ... for more information
Current Dermatology services are not sustainable with increasing demand and national shortage of Dermatologists. Referral rates from primary care continue to rise, widening the capacity gap and increasing waiting times. Teledermatology was suggested ... for more information
Abertawe Bro Morgannwg University Health Board faced escalating patient did not attend (DNA) rates across many specialities. The introduction of partial booking for ‘new’ patient appointments aims to benefit patients and the organisation in many... for more information
In April 2014, 13% of patients were waiting in excess of 26 weeks for a new outpatient appointment with 1,624 Follow up not booked (FUNB) patients waiting in excess of their target date. Improvements to the service were based on implementation of... for more information
The paediatric outpatient department at Cardiff and Vale University Health Board faces unprecedented demand. Referrals have increased by nearly 40% in the last 8 years. Many of these children could be managed in primary. A group of paediatricians... for more information
The number of urgent dermatology patient referrals from primary care was increasing. Referrals were often of variable quality, resulting in unnecessary outpatient appointments. The aim of this project was to; • Reduce barriers to Teledermatology for ... for more information