What is the challenge your project is going to address and how does it connect to your chosen theme?

It can be frustrating attending an outpatient department (OPD). I have worked in neurology OPD for many years and the way tests are arranged in series makes for drawn out clinical processes and long uncertain  waits between appointments; repeat journeys add carbon load to the uncertainty of waiting and the difficulty of planning a personal diary.

I propose that OPD teams look at ways to revise what they do aiming for a ‘one stop shop’ model, maybe consulting more than one health professional. This lends itself to simple, low tech investigations such as urinary flow rates in a prostate one stop setting. Where it is more difficult, IT systems could screen ‘live’ capacity for free investigation slots (for imaging or neurophysiology in the case of neurology) when the patient is in OPD which could be used before going home.

If this is not possible the patient should go home with specified times for their proposed investigations and OPD review appointment so they can plan around them.

What does your project aim to achieve?

By putting the patient at the centre of the project the aim is to make outpatient medicine a better process – quicker, more efficient and less of an obstacle to daily life.

The work would involve liaising with the clinical director of the local hospital (RCH Treliske), outpatient staff at the hospital, those involved with clinical tests such as imaging, neurophysiology, cardiac tests etc and with Andrew Abbott at the Kernow Clinical Commissioning Group who would have oversight of OPD costs.

Working with all parties the aim would be to reformat OPD services using patient satisfaction and cost impacts as outcomes. Times from referral to diagnosis could be compared before and after intervention and the number of missed appointments for review and investigation.

An effective redesigned service has the potential to reduce the carbon foot print of OPD appointments which is central to the longer term aim of better sustainable health for all.

How will the project be delivered?

I propose the following people are consulted:

1) Expert patients / service users at an early stage to run the ideas past them and keep them patient centred – what would a good experience look like?

2) The clinical director at RCHT Treliske since would have responsibility for internal re-organisation, advising on potential time frame and mechanism for delivery.

3) OPD co-ordinators under the clinical director would have practical advice on what would be likely to be work and advise on workflow and capacity.

4) Staff involved in providing investigations (e.g. radiology) to ensure there is capacity for more parallel working to succeed and how to enable it.

5) Canvassing ideas from GPs who refer patients into OPD about what reconfigured systems might look like.

6) There are some other Q members in Q within Cornwall and it would be useful to seek feedback from them as well as any other similar projects that could be drawn on.

7) Andrew Abbott as lead of the local CCG.

What and how is your project going to share learning throughout?

I am not an expert on OPD structures but I have worked in many different hospitals and they have tended to share the same practices; these seem to be based on what works for clinicians and hospital systems rather than what is most convenient for patients.

By trying to apply some systematic pressure towards more patient centred design, reducing the number of return appointments by offering more contacts and / or tests in one visit and a clear timeline for follow up, I hope the Q community would be supporting some practical work with a tangible benefit for patients, based on some conclusive outcome data (I hope).