38 Improving Access to Outpatient Services for Older People Using A Clinical Microsystems Approach

Background Northumbria Healthcare NHS Foundation Trust provides services to more than 500,000 residents in the North-East of England across multiple sites. Local problem Outpatient services for older people across Northumbria include specialist (eg falls) and generic clinics with differing referral routes, demands and waiting times. Referrals derive from primary care, emergency services and elsewhere; some are complex patients requiring a comprehensive geriatric assessment (CGA). Existing pathways led to variable waits for clinics, duplication and delays. Aim was to improve the timeliness, efficiency and access to appropriate assessment first time. Methods We adopted a Clinical Microsystems approach (Sheffield Microsystems Coaching Academy) for improvement. Main components were team coaching, weekly “Big Room” meeting of involved staff to share understanding of current process, agree change ideas, and test these with multiple plan, do, study, act (PDSA) cycles. Impacts of each PDSA cycle were discussed in Big Room, leading to refinement of the pathway. Interventions Results: PDSA interventions were tested over 6 months: Development of a single triage systemCGA clinic for frail older patients.Development of shared documentation for CGA.Improved cycle and lead times for assessment Conclusions Our quality improvement work supported the development and implementation of a new referral triage process with CGA assessment for complex frail patients. The change has reduced patient wait times, provided early intervention and reduced duplication. Work is ongoing to determine impact on patient satisfaction and time to discharge from clinic. The approach taken by this project could be applied elsewhere to improve outpatient referral processes.