1. Dan Clutterbuck Consultant GUM March 2013
Lothian ICP for HIV
Dan Clutterbuck
Consultant GUM
March 2013

2. Lothian Situation Two clinics providing HIV care
GUM Clinic (Chalmers)
Infectious Diseases Unit
Different models of care
Combination of data recording systems
Paper notes/ proformas
In-house database
TRAK (RIDU) and NaSH (Chalmers)

3. Process Initial meeting 9th June 2010 Options considered
ICP for diagnosis
Chronic treatment (outpatient visits)
Starting therapy
Acute admissions
Start with an ICP for diagnosis
In parallel with national ICP developments

4. ICP for first 3 months of care
20 individuals on ICP team
Process mapping in both units
Draft ICP pre-piloted with 10 individuals, redrafted late 2011
1 year pilot commenced April 2012
15 formal meetings to date, 2 team ‘brainstorming’ sessions
ICP facilitator support on a voluntary basis

5. Results
55 of 63 newly diagnosed or transferring in HIV patients completed the ICP by February 2013 (37/40 in GUM and 18/23 in ID)
Of 24 essential items a mean of 16.8 in ID and 19.9 in GUM were completed overall.
Completion of fields was high for sexual health in both units (53/55 overall) and lowest for ‘Plan for out of hours care’. 

6. Variance recording
Variances were well recorded for ‘Consent to GP disclosure’ (Not completed in 17, variance recorded in 12) but less well for ‘cardiovascular risk assessment’ (Not completed in 37, variance recorded in 15).
Completion was not 100% even for items identified by the clinical team as essential (e.g. STI screen; not completed in 15, variance recorded in 9)

7. Learning
Different processes make single document a challenge (inpatient medical vs outpatient multidisciplinary models)
Nursing team drive forward use/completion
Numerous system and clinical questions arise in development
New patient review meeting
Annual review process and patient choice
Standard legal/transmission information

8. Next steps
Planned/Unplanned visit documentation introduced in Chalmers Jan 2013
Decision to incorporate Annual Review documentation into Access database
Move to electronic record when complete
Flexibility in timing of completion of different elements
Development of patient questionnaire

9. Next steps Collation of data from 1 year pilot
Submission of poster at ICP conference
Feedback day to clinical teams July 2013
Agree 5 priority areas for 100% variance recording
Incorporation of data and variance recording in local database
Patient questionnaire
Patient views on pathways, delivery, processes

10. Database

11. ICP form

12. Variance recording

13. Thank you ICP Team David Wilks, Alan Wilson – HIV Database
Linda Panton, RIDU HIV nursing
Alan Fisher, NHS Lothian ICP support
Hosanna Bankhead, THT/HIV Scotland- patient/user representative