MCAP Internal Delays Diagnostics - Maidstone and Tunbridge Wells NHS Trust
ISSUE
The MCAP approach highlighted Diagnostics as one of the top internal delays to patient flow, and a further analysis focused the team on the specific challenges. An initiative was commenced looking at the Echocardiogram Service and the impact on LoS at the Hospital. Previously, when doctors requested inpatient Echocardiogram (ECG), communication with the cardio-respiratory team was poor. Patients would routinely wait prolonged periods; unbeknown to the medical team the patient did not in fact meet the NICE guidance and criteria for inpatient ECGs resulting in internal delay for non-qualified patients. The cardio-respiratory team would only perform these ECGs only when they had a gap in Workload so the Ward Team had the perception of long waits for ECGs.
SOLUTION
MCAP reviews were completed daily on the morning and all ECGs previously requested were re-reviewed as to their appropriateness. Daily reports were forwarded to matrons, consultants, diagnostic team leaders and the assistant general manager for cardio-respiratory to ensure appropriate prioritising of requests. Feedback was then provided to the ward as was the NICE guidance and criteria for inpatient ECGs. MCAP reviews were utilised to highlight previous delay trends; encouraging consultant involvement to ensure accessibility. The aim was to reduce LOS by reviewing ECG requests for both qualified and non-qualified patients in a timely manner, amending requests to outpatient appointments or cancelling when necessary.
OUTCOME
This initiative saw a reduction in average LOS of 2.35 days for this patient group over 6 months. There was a behavioural change, good consultant engagement (specifically days with no planned ward rounds) and a 10% increase of re-requesting ECGs as an outpatient diagnostic for clinic or GP follow-up or cancelling of the diagnostic all together. The further analysis of MCAP reviews and ECG requests were fed-back at clinical governance highlighting areas identified as experiencing the most consecutive non-qualified delays. For example; patients admitted to CCU with the longest LOS received ECGs within four hours whereas patients’ experiencing the longest delay, on the gastroenterology ward generally saw patients discharged the same or next day as their ECG – further evidence that the ECG was potentially not a major factor in their acute management.