1. Discovery in Action: Case Study
Case Study:- Discovery use to support change in practice
Topic: -Variation in New Outpatient Referral Rates

2. Methodology
Identified variation of New Outpatient Referral Rates. (Slide 3)
Investigated this further by speciality. (Slides 3 and 4). Note possible to export this data from the Discovery Tool
Used this information to identify those specialities with the greatest potential productive opportunities compared to their Peers. Analysed referral rates by age/sex (Slide 5) and also local authority and GP practice to see if the information identifies any obvious outliers (Slide 6 to 8)
HB established a project pilot to redesign the whole referral pathway for a specific speciality, they needed GP support for this to help manage demand. The ability to quickly access Discovery information to respond to queries was very helpful.

3. Discovery: Level 1 Overview –Residence: Location Overview Tab
This Dashboard identifies the standardised rate for New Outpatient Referral Rates This is standardised by Age and Sex at Level 1.
Overall for this HB of Residence their Standardised rate is 386 (per 1,000) V a Scottish Rate of 360.
The selected LA Residents Referral Rate is 386 (per 1,000), and are 5th out of 12 LA Peers, for this time period
Generally the overall Referral Rate for this follows the Peer Average monthly trend but is a bit higher.
Speciality Split benchmarking available in the bottom bar Graph Can Quickly see that C8 Orthopaedics referral rate is higher than peer rate (green line).
There is also a within Board function that allows all LA within the HB be compared.

4. Discovery: Level 1 Overview –Residence: Location Overview + Impact Analysis Tab Trauma and Orthopaedic Focus
Focusing on Trauma and Orthopaedics shows that
their referral rate is 44 (per 1,000), peer average rate 33, Peer UQ rate 31.
From the Impact Analysis tab for this local authority to meet their Peer UQ rate for this time period would require a reduction in T&O activity by 2,215 New OP appointments.

5. Discovery: Level 2 New Outpatient Referral Rate: Demographic Tab LA 4 Residents:- Trauma and Orthopaedics Specialty
Age and Gender Split shows that for this Local Authority area the referral rate for working age patients is higher than their peers.

6. Discovery: Level 2 New Outpatient Referral Rate: GP Practice Tab LA 4 Residents:- Trauma and Orthopaedics Specialty
This Tab compares referral rates for the GP practices of LA 4 Residents.
If user hovers over dot, further information appears. Scatter plot chart shows variation although there is no obvious relationship between Practice size and referral rate.
Table below provides activity, practice population size and Referral Rate information by GP practice.

7. Discovery: Level 2 GP Summary Dashboard:- GP Activity Tab Specialty:- Trauma and Orthopaedics:- New OP Activity Rates
The GP Cluster Summary Dashboard combines a number of indicator information that is available by GP practice.
Activity information is available as is rate information per 1,000 of the GP population (based on latest GP List size)
In this dashboard ,activity is linked to the specific GP practice recorded at the time of the activity, no matter where this activity takes place or where the patient lives.
It can be seen that GP practices have a range of referral rates (per 1,000). Comparisons available against GP Clusters, HB and Scotland.
User can flick between numbers and rates.
Trend information also can identified any changes over time .

8. Discovery: Level 2 Local Authority Summary
This Dashboard compares all residence indicators for a Local Authority compared against its HB and Scotland
User can flick between numbers and rates.
Trend information also available and can identify changes over time.

9. Case Study:- Discovery use to support change in practice:- Background
Background:- This HB had identified a capacity problem in a specific speciality.
HB established a project pilot to redesign the whole referral pathway, they needed GP support for this to help manage demand
They used the information available in Discovery as part of this analysis and summary Discovery information was also used to begin the conversation with the relevant GP practices. The ability to quickly access Discovery information to respond to queries was very helpful.
Whole Pathway for this speciality has been redesigned, establishment of
Consistent Vetting
Real time clinics
Nurse Advice for patients
Telephone advice available for GPs
Telemedicine project (based on work ongoing with the WI)

10. Case Study:-Using Discovery to help Monitor Impact
Key KPI’s to monitor impact
New Outpatient Activity/Referral Rate reduction over time
Ability to benchmark pilot area against other areas is in Discovery
Monitoring of New OP DNA rates
Expected reduction of DNA rates as more support is available in the community so only the most appropriate people are referred.
Monitoring of GP Referral Rates
To help assess uptake of additional redesigned support across all GP practices

11. Using Discovery to Monitoring Change Discovery: Level 1 Overview –Residence: Location Overview
Indicator New Outpatient Booked Appointment Rates:-
Trend chart shows that this improvement project is having a positive effect.
For orthopaedics referral rates in 16/17 was (per 1,000) for 17/18 it is It can be seen this improvement is continuing into 2019.
This LA Referral Rate is now better than their peer average rate
There is also a within Board function that allows all LA within the HB be compared.

12. Using Discovery to Monitoring Change Discovery: Level 1 Overview –Residence: Impact Analysis
Indicator New Outpatient Booked Appointment Rates:-
Specialty: Trauma and Orthopaedics
The Time Trend highlights that the gap/bar is getting smaller over time. This means this locations performance is getting closer to the UQ rate of their peers.
In fact in 2018 Q3 this LA meeting the UQ rate of its peers, and this was maintained for the next quarter.
There is also a within Board function that allows all LA within the HB be compared.

13. Case Study:- Summary
Discovery Information complimented Local Information in the development of the Pilot.
Having quick access to data through Discovery helped engagement with the GP practices.
Ability to use Discovery to monitor trends and compare and contrast pilot areas with other areas to assess impact is useful.
For Further Information on this case study please contact the Discovery Team.

14. For Discovery support and more information on accessing and using NSS Discovery, email us at:  or
visit our website:
nssdiscovery.scot.nhs.uk