1. Department of Clinical Neurophysiology Glasgow The Waiting Times Challenge Anne Peden Professional Services Manager

2. Background We provide a wide range of Neurophysiological investigations to a potential patient referral base of 2.7 million. Investigation performed include: Standard EEG Sleep Deprived EEG Short Video EEG EEG Monitoring including Intra-cranial recording Evoked Potentials EMG investigations, including Physiologist Led Nerve Conduction Studies

3. Staffing 3 Consultant Clinical Neurophysiologists. 1 Locum Consultant. 2 Specialist Registrars. 10 WTE Clinical Physiologists (7 at SGH, 1 at WIG, 1 at GRI and 1 at SEC Bridge of Weir). 4 Trainee Clinical Physiologists. 1 Assistant Clinical Physiologist. 4 Administrative staff.

4. Waiting Times At Jan 10 waiting times: InvestigationMin(weeks)Max(weeks)Min(months)Max(months) EEG/Short Video Clinical Urgency 401 Amb81022.5 VT4611.5 EMG/NCSClinical urgency 112028

5. Why?

6. Due to: Significant expansion of Orthopaedic and Neurology services in West of Scotland. In 1999/2000: There were only two Consultant Clinical Neurophysiologists employed within the department. Development also began of Specialised EEG Monitoring Services in Glasgow (including Intra-cranial recording). 2008/2009: Despite having 3 Consultant Clinical Neurophysiologists, they were dealing with a growth of 300% in EMG referrals along with other clinical commitments.

7. What have we done? Look at skill base of staff. Room utilisation: Where and when are labs free. Appointment slots: Increased EEG and Ambulatory appointments to ensure that these waits remain manageable. Re-organize EP clinics to set day/ times, to free-up space for additional NCS From June 09 introduced Physiologist Led Clinics for Carpal Tunnel Syndrome. Now have 4.5 Clinical Physiologists able to perform NCS (5 clinics per week). 1 Physiologists assisting clinic for NCS. Additional Locum Consultant appointed August 09

8. Outcome- Physiologist Clinics

9. What's next: Waiting List Initiative Clinics for Consultant investigations, from March to May 2010. Pooled EMG referrals, for Consultant led clinics (March 2010). Common vetting for all EMG referrals.(Urgent, Routine and Phys) Up to 45% of all referrals suitable for phys clinics. Increase number of Consultants from 3 to 5 by June 2010. Increase number of Physiologist Clinics from 6 to 10 by June 2010, thereby freeing up consultant time to deal with complicated investigations.

10. Conclusion Changes we have made have had a significant impact on waiting times and therefore improved the quality of service we provide to our patients. We realise there is still a lot of work to do, but we are heading in the right direction!