What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Our projects works across the Birmingham and Solihull ICB to optimise referral processes, especially for spirometry. Currently there are multiple services, with different offers and referral mechanisms, and some patients end up being cared for in multiple places, or seeing a hospital service when a community one would work better for their needs. Diagnostic tests like spirometry are a particular problem, which delays appropriate treatment. Currently waiting time for respiratory review is 27 weeks on average in our Trust, but exceeds 52 weeks for some specialist services. Many new outpatient appointments are used for cases where a diagnostic hub, or a community team respiratory review may be more appropriate, which contributes to this problem. If mechanisms to filter and direct referrals were improved we could use services more efficiently across community and secondary care, and reduce waits and waste simultaneously. This directly addresses the question about improvement across system boundaries.

What does your project aim to achieve?

Our objectives are to reduce waiting times for spirometry and respiratory review by 40% over 1 year, and to improve patient and healthcare professional satisfaction with the referral process from baseline. It has potential to reduce healthcare inequality by bringing care to the most appropriate service first time – for example secondary care appointments may be difficult to access for some people, which prompts disengagement. Making it community based could address this.

How will the project be delivered?

Our ICB and Asthma + Lung UK (the major respiratory patient facing charity in the UK) have engaged with one another to support appointment of respiratory champions to support integration, and this project will be led by the respiratory team (Alice Turner) along with the integrated care lead from UHB (Paul Cockwell). We will use the budget for support staff to manage the project, for patient and stakeholder meetings, and for improvement team members to analyse data and develop the improvement plan for referrals. Digital innovation, such as embedding new ways of referring for spirometry (delivered by secondary care staff at community sites) into primary care systems will occur in parallel via our informatics teams. Existing budget and software from the CDC digital innovation stream will support the latter endeavour.

How is your project going to share learning?

We will share learning via presentations and publications, not only locally and via Q community but also via the British Thoracic Society Respiratory Futures and Integrated Care platforms, Primary Care Respiratory Society, and National Respiratory Audit Programme (NRAP). Our project lead (Alice Turner) is NRAP Improvement Lead, which gives our project a platform from which to launch, supported by the Royal College of Physicians. We will report in the form of case studies, and will develop training packages and suggested PDSA cycles for other areas wishing to adopt similar changes. Talking heads style videos and infographics will be used for social media platforms. Finally we will work with Asthma + Lung UK to ensure we have patient based dissemination as well.