CWS Clinic Builds 26 September 2018 18/01/2019 Pam Stein EPR Clinical Analyst & Lesley English EPR Application Analyst  CWS Clinic Builds 26 September 2018

Basic OP Clinic Build Advantages to conventional Meditech build 18/01/2019 Basic OP Clinic Build Advantages to conventional Meditech build Fewer clicks Less filtering/drill down See Consultant schedule for any given day See specific clinic for any given day This is for a standard, consultant led clinic where only 1 consultant attends. Location, clinic schedule and appointment types are all associated to the clinic. Clinic built this way to enable easy visibility for consultants to see the capacity of individual clinics. Also for Admin support to view a single clinic without having to filter. Consultant/Location specific. All clinics also have a unique numeric.

Chemo Delivery Model 18/01/2019 Previous – paper based & Consultant based. 1 scheduling team based at Clatterbridge 8 Hubs throughout the region with varying capacity & dates of operation Appointments in half hour blocks, with given number of slots. No consideration to number of nurses/chairs/length of administration time. Going forward Procedure clinics, not associated to doctor Take account of clinic times, number of nurses, chair capacity and other resources (scalp cooling, beds) Need to be able to identify when nursing & physical resources were at capacity Needed to be able to identify accurate waiting times Factor in nurses lunch breaks but be able to continue treatment already started (in chairs) Give realistic appointment times to patients Spread the workload more evenly across the day. Avoid morning gluts Encourage patient to have bloods day before

The Hair Dresser Analogy 18/01/2019 The Hair Dresser Analogy Going from paper based system, many people could not understand why nurses need to be included in the appointment. NHS attitude tend to be “there is a chair available” Making an Appointment at the Hair Dresser analogy clearly demonstrated the reason. Saw many “light bulb” moments

18/01/2019 Resource Schedules Resource Schedule for CHAIRS in Bay 1 is maximum of 6 chairs Resource Schedule for NURSES in Bay 1 is much more complex

Appointment Types Build 18/01/2019 Appointment Types Build

18/01/2019 Hub Overview When an appointment is made with a nurse, the chair is booked in the background. Both resource must be available in order for an appointment to be made When choosing a clinic, the scheduler

Creating a Hub Overview 18/01/2019 Creating a Hub Overview Create a resource Group for the Hub In each of the Nurse Schedules associated with the Hub, include the Resource Group name

Admin Services Clinic Management 18/01/2019 Admin Services Clinic Management Problem! We discovered that we had a consultant led clinic but with 4 consultants attending instead of just the usual 1 This was incredibly difficult for the Admin Team to manage effectively Capacity management tended to be left to the secretary which made her stress levels go through the roof! Recording the consultant’s activity was also difficult and therefore inaccurate.

Admin Services Clinic Management 18/01/2019 Admin Services Clinic Management Requirements? What do we need to make this more manageable for our Admin support staff? Visibility of the capacity for all consultants attending that clinic A ‘one stop shop’ where we can book and edit appointments. The ability to move appointments from one consultant to another without the need to cancel and re-book.

Admin Services Clinic Management 18/01/2019 Admin Services Clinic Management Solution Adapt the Chemo delivery build to enable the Admin Team to manage the multi consultant clinics in a more efficient manner. Rebuild the existing consultant led clinic as an ‘umbrella’ (hub) clinic with multi clinicians (workstreams) working within it.

Front End View 18/01/2019 Usual editing functions available This example shows the variety of streams that can exist within 1 umbrella clinic (2 x consultants, 3 x ANP’s, 2 x CNS’s and a pharmacist)

Multi Consultant Outpatient Review Clinics 18/01/2019 Multi Consultant Outpatient Review Clinics Instead of chairs and nurses, we have consultants and workstreams Each Clinician has their own easily identifiable workstream within the clinic. Enables us to manage our consultant’s activity Here, stream 1 is associated to the consultant NB

Multi Consultant Outpatient Review Clinics 18/01/2019 Multi Consultant Outpatient Review Clinics Another stream within the same clinic yet associated to a different consultant - CEJ If you were wondering what the number is in the name of the clinic, all our OP review clinics have a unique numeric code which is used to search for appointments and identify the clinic This is used across our Admin teams for our Review clinics.

18/01/2019 Workstreams Each work stream schedule is profiled into timeslots and each timeslot will be profiled with the relevant appointment types (in this instance and for this clinic the consultants can see all appt types) We also add the Responsible Clinician for that stream. This pulls through to the Booking Screen which in turn records the consultant activity.

Restrictions 18/01/2019 Manage overbooking for the individual stream Set restrictions for how many New and Follow up appts can be booked to the stream eg the profiled number of F appts in the clinic is 4. If we set the MAX Follow Up/Day to 5 it means that even though overbooking has been taken off the stream you could book 1 extra Follow Up if needed. This means that we can keep a little flexibility for urgent appointments. These extra appointments are managed by our secretaries and are only used at the consultant’s request.

Appointment Types Example 1 Example 2 18/01/2019 In the Appointment Type dictionary we can restrict which appointments can be booked to a work stream. In the 1st example shown, the F appointment type can be booked to all streams. ANP’s, CNS have specific appointment types which are restricted to their own streams as shown in example 2. Done by using the Include/Exclude list. If appointment type is restricted to a stream it cannot be booked or pasted into another stream.

Booking Appointment 18/01/2019 Follow Up appointment slot at 09:20 in stream 1 for the consultant NB has been selected. N (40M) denotes a new patient slot with a duration of 40 mins F (20) is a follow up appt slot and is 20 mins long Patient 1, 2, 3 etc are bookings that have been redacted.

18/01/2019 Booking Screen The consultant, date and time automatically populate in booking screen. We can see the Resource Group and Schedule and the duration of the appointment. Had we selected a different stream, the consultant relevant to that stream would have populated. For ANP’s, CNS’ etc apptointments will default to the lead consultant of the clinic when booking. In summary, this shows how we used the Chemo treatment build to create a clinic management tool for Admin Services that has helped alleviate the problem of multi disciplinary clinics.

18/01/2019 Conclusions: Q&A To conclude, this demonstrates how we have used the same build effectively in two very different clinic environments and for very different reasons managing the time of the chemo nurses as well as the individual chemo treatment to enable us to accurately record the activity of clinicians to organise the bookings to the Multi Stream. Review clinics which will help minimise waiting times and therefore result in a better patient experience. Questions? Leave email addresses for further info.