What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Patients with Irritable Bowel Syndrome (IBS) referred for dietetic advice have historically experienced long waits for an appointment due to high demand. Evidence suggests that dietary advice can reduce demand on GPs and improve self-management (Williams et al, 2020) and it is recommended by NICE.

Opt-in for new referrals and webinar advice was introduced to improve timely access to first line dietary advice. However, 63% of patients with IBS, referred to the dietetic service, do not opt in for a first appointment with reasons for this currently unclear.

In addition, following opt in to an appointment, approximately 14% of patients do not attend (DNA) their first appointment and approximately 17% DNA a follow up appointment.

Investigating the current service delivery model and working with patients to understand the barriers and enablers to accessing the service will identify tests of change to improve how patients utilise and benefit from the service and reduce waiting times.

What does your project aim to achieve?

Aims:

To improve access to dietetic advice and reduce DNA rates for patients with IBS.

To identify reasons for non attendance and revise the pathway to meet the needs of patients with IBS and increase the number of these patients utilising the dietetic service.

The project has the following objectives:

-Understand the reasons for patients not opting into an appointment

-Understand the reasons for first and follow up appointment DNA when opted in

-Understand the reasons for not using Patient Hub as a method of communication about appointment details

-Identify any health inequalities which are impacting the reasons above

-Collaborate with key stakeholders, other Trusts and Q community to develop project idea

-Using the reasons identified above and working with patients, test change ideas to increase engagement in dietary advice and attendance

-Consider and test the use of Patient Initiated Follow Up (PIFU) following first appointment in specific patient groups

How will the project be delivered?

Key stakeholders: Patients, Dietitians, Clerical Officer, Head of Nutrition and Dietetics, Business Manager, Service Manager, Clinical Quality Lead for Adult Therapies, Gastroenterology team

Phase 1:  Identify key measures to evaluate impact e.g. Opt in and DNA rates and cost/ potential cost saving. Identify any risks with potential increase in demand. Develop communication tools/ mechanisms with dietitian, patients and clerical officer.

Phase 2: Communicate with patients who do not opt in and those who DNA to identify reasons and collate themes.

Phase 3: Use themes to identify change ideas to start testing, measuring the impact throughout to identify effective interventions.

Phase 4: Review of data collected during phase 2 and 3 and report writing. Sharing of progress/ learning within Leeds Teaching Hospital, regional and national conferences.

A dietitian and clerical officer will undertake the project work with additional support, guidance and oversight provided by the Head of Dietetics, Business Manager, Service Manager and the Clinical Quality Lead.

How is your project going to share learning?

Use platforms such as the Q Community and Future NHS Collaboration to generate ideas and share learning.

The results will indicate where patients are not opting in and themes as to the reasons for this. Other services could have the same/ similar barriers therefore sharing this may generate ideas for improvement elsewhere.

Involving key stakeholders in the project, such as referrers in the IBS pathway and patients, and sharing the results, will help promote the responsibility of key stakeholders in the patient pathway – i.e. referrer, treating clinician and patient (Triangle of equal responsibility).

The ideas and tests of change and learning from these could be shared and trialled in many other outpatient services both internally and nationally.

There will also be learning related to how to engage and involve patients in identifying areas for improvement and using this to reduce health inequalities within the service and beyond.