Mandy Rayani (SRO), Director of Nursing, Quality and Patient Experience
Mandy Davies (Project Lead), Assistant Director of Nursing, Quality and Patient Experience
Hywel Dda University Health Board
The Covid-19 pandemic has meant that planned surgery waiting times have increased significantly and the Waiting List Support Service (WLSS) pilot was developed in response to this. The aim was to develop a service which tested a process that proactively and compassionately communicated with patients who were on a waiting list.
We piloted an approach on a small cohort of orthopaedic patients (264) that had been waiting 52 weeks or over. They were contacted via a letter, which contained a link to an online resource specifically tailored for their condition as well as an offer of telephone support and advice.
To develop a service for people which could communicate in a personalised and compassionate way whilst they were waiting for care. The service would provide support and guidance which could help prevent deterioration and promote healthy pre-habilitation, the goals being:
· People are able to access a responsive service;
· People are able to access information when needed;
· People are able to manage their own health better;
· People are more satisfied with the service they receive;
· Clinical staff have more time to deliver clinical activities.
· Explore needs around patient care pathway
To write to the cohort involved in the pilot and offer bi-lingual bespoke online resources for their condition and a telephone number/email which they could contact someone if they had any queries. The telephone line/email would be operational five days per week and be supported by pre-assessment Nurses with access to a specialist pain Nurse, reducing the need for unnecessary consultant engagement.
To undertake a comprehensive evaluation of the service in order to inform the potential roll out of the initiative to other service areas. This would include patient experience measures as well as impact on numbers of call through to Medical Secretaries/Consultants and peoples usage of the online resources.
Initial scoping identified no centralised or standardised process in place to contact patients across Hywel Dda University Health Board (HDdUHB), nor was there a single call handling approach to managing calls from patients who were waiting for elective surgery and needing advice or assistance to prevent deterioration of their condition.
A key challenge was to engage with clinicians and managers on the potential benefits of the WLSS in order to work collaboratively in the development and evaluation of the service. As such, right from the start the project team engaged and co-developed key aspects of the WLSS with core stakeholders.
Patients manage their condition while waiting with the online resources developed.
There were 84 hits to the orthopaedic webpage between 27th April and 12 May with an average of a 4 minute stay, twice as long as normal site viewers. 27% of recorded site views were patients returning to the online resource after looking at it before.
Spikes in website usage line up with dates when letters would have been received in batches. Later website hits are likely to be those returning to the site.
Image: Page views over time. Pilot Start Date 26th April – First Batch of Letters Received 28th April
Early indications are the letter had the following impact; 25% of patients used the unique QR code to access the website provided in the letter and 6% used the telephone line for additional information.
Patient experience captures positive service feedback
82% out of the 10 patients surveyed answered ‘Always’ for the following questions;
Did you feel that you were listened to?
Did you feel well cared for?
Did you feel you understood what was happening in your care?
Were things explained to you in a way that you could understand?
Were you involved as much as you wanted to be in decisions about your care?
The remainder answered ‘Usually’ (12%) or ‘Sometimes’ (6%). Lower scores seemed to be linked to waiting list time, as comments around call handlers were very positive.
Efficient use of resources
We asked medical secretaries whose patients were involved in the pilot a series of questions, the most notable outcomes were that during the pilot they received;
Between 50%-60% fewer calls
Fewer calls about Waiting List times (when will surgery take place),
Calls which were more relevant (i.e. booking appointment with consultant for change in symptoms)
Learning from the project will be used to roll out the WLSS to other planned surgery services throughout HDdUHB. The evaluation has highlighted that whilst only a small percentage of people took up the offer of telephone communication the support and advice asked for was successfully managed, and that the bespoke online resources developed were well received and used. This will shape the approach to the wider roll out of the WLSS. Furthermore, we learned that we need to include more information on falls prevention as this has been found to be a concern for our patients.
Our Exemplar Experience
The Bevan Commission provided the opportunity, skills and assurances to explore and break down a complex project with ongoing support.