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Rheumatology Case study: Guy's and St Thomas' NHS Trust

Rheumatology Outpatients - Context

Clinicians were frustrated that they were spending too much time on routine follow-up with “well patients”, while simultaneously struggling to staff urgent clinics and see new patients as quickly as they would like. 

They sought a solution that could help them to identify at scale stable patients scheduled to be seen sooner than necessary, so that their appointments could be moved back, releasing capacity for higher priority uses.

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Our methodology - clinical intent

We worked with clinicians to develop a set of “rules” that could be applied to patients’ existing electronic records. 

The rules look at patients’ appointment histories, PROMs (RAID/PsAID/BASDAI), CRP results, diagnoses, medications, and vulnerabilities and classify upcoming appointments as either "potentially deferrable" or not.

At monthly intervals, approximately 6 weeks in advance, all in-scope follow-up appointments were “scored” by the rules.  “Potentially deferrable” appointments were reviewed by clinicians.  Those they agreed to defer were passed to the admin team to be re-booked.

Patients were given the option to keep their existing appointments, but the majority chose to accept deferral.

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Rheumatology Results

The rules developed were extensively tested and performed exceptionally well, with clinicians agreeing that appointments classified as “potentially deferrable” were indeed deferrable, in 88% of cases (in blind testing of around 100 appointments).

In practice:

  • The rules identified 44% of appointments as potentially deferrable

  • Clinicians agreed to defer (or in some cases to discharge) 68% of “potentially deferrable” appointments presented to them

  • Reviews took 1-2 minutes per appointment

  • 79% of patients contacted accepted deferral

  • 0.56 follow-up appointments were released per deferral (appointment intervals moving from an average of 9 to an average of 16 months)

  • Clinician time spent reviewing appointments “paid back” 6-fold in capacity released

Follow-up activity was reduced by 13.5% in clinics where the process was fully implemented

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"Our experience of working with Factor 50 colleagues has been extremely positive. They have offered a great blend of technical skills, responsiveness and the ability to stimulate great clinical engagement and leadership."

Daghni Rajasingam, Deputy Medical Director, Guy's and St Thomas' NHS Foundation Trust

"The joint working between our diabetes multidisciplinary team and the Factor 50 team has led to development of data led clinical prioritisation tool,  an exemplar of how health informatics can make a real clinical impact and lead to improvement in the quality of care for people with diabetes."

Dr Janaka Karalliedde, Consultant in diabetes, endocrinology and internal medicine, Guy's and St Thomas' NHS Foundation Trust

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Further References

The Deputy Medical Director, the Lead Diabetes Consultant and the Transformation Director have all said that they would be happy to speak to other members of the NHS about their experiences working with us.

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