Improvement Stories
Pilot site improvement stories
Triage in Primary Care: a new pathway for hearing aid candidates
Leicester Royal Infirmary worked collaboratively with primary care practices to triages patients using a small screen device (Siemens Hear Check Screeners) and a short questionnaire. Pilot work has shown than locally, approximately 40% of patients are suitable for an ‘assess and fit’ model, thereby saving 30 mins appointment time per patient. To find out how this was achieved click HERE.
Developing new pathways for patients requiring reassessment of hearing needs
Nottingham University Hospitals NHS Trust moved reassessment services into the community and enabled greater numbers of patient to be seen within existing resources by triage of reassessment hearing appointments into those patients that required limited fine tuning to be treated separately from those requiring a full audiological reassessment. To find out how this was achieved click HERE.
Care in the community for those needing diagnostic assessment
Trafford Healthcare NHS Trust improved access for hearing assessment clinics by the provision of two additional community based services and reviewed existing skill mix and roles. Assistant practitioner roles were extended and a reduction in the numbers of steps in the traditional pathway was reduced. Click HERE to find out how this was achieved.
Direct Access Tinnitus Service
University Hospitals of Birmingham NHS Foundation Trust worked collaboratively with ENT Consultants to enable GP’s to refer directly to an Audiologist/ Hearing Therapist Tinnitus Clinic to streamline Tinnitus referral pathways. Earlier access to the clinic has enabled patients to receive consistent information and improved the patient’s ability to adopt self management strategies. Early findings suggest a potential reduction in follow up appointments. To find out how this was done and the impact click HERE.
Direct Access Tinnitus Service
Sherwood Forest Hospitals NHS Foundation Trust reduced new to follow up ratios , improved access and quality of patients experience via implementation of a Direct Access Tinnitus Service model. Patients are now seen in the clinic in less than 4 weeks and 75% of ENT Tinnitus outpatient capacity per annum has been released. Click HERE to find out how they achieved this.
‘One Stop’ Audiologist Led Balance Service
The National Hospital for Neurology and Neurosurgery, Queens Square, London, introduced a ‘one-stop’ balance clinic with same day testing, diagnosis, physiotherapy and cognitive behavioural therapy, in collaboration with audiovestibular medicine. Experienced band 7/8 audiologist received additional training so they were able to see some straightforward GP referrals in place of audio-vestibular medicine. Click HERE to find out how they did it.
Review of Balance Pathway
Cambridge University Hospitals NHS Foundation Trust held a patient forum to probe the issues important to their users and changes made as a result were fed back. Written patient pathways and information were reviewed. Clinical teams produced a service topography data set, introduced individual management plans and patient outcomes data base was established. Click HERE to find out more.
Redesign of Balance Pathway
The Heart of England NHS Foundation Trust redesigned their pathway to enable access to other specialist services without having to return to their GP for a new referral by agreeing referral criteria for access to the service and for onward referral into acute or specialist balance service. A patient discovery interviewed was conducted to share the experience of the pathway from a patients perspective which provided evidence for the pathway redesign. Click HERE to find out more.
Collaboratively working with ENT to triage Hearing, Balance and Tinnitus referrals
Royal National Throat Nose and Ear Hospital, part of Royal Free Hampstead Hospital NHS Trust, worked collaboratively with ENT Consultants to validate Senior Audiologist assessment skills to enable a case to be made for streamlining of referrals to ENT or Audiovestibular Medicine via expansion of Direct access Tinnitus, Balance and Hearing pathways. 75% of ENT Otological referrals could potentially be managed by the diagnositc audiology department in a direct access servic. Click HERE to find out how they did it.
Adult Complex Hearing Needs Pathway redesign and SHA Network development
Central Manchester University Hospital NHS Foundation Trust streamlined referrals from local providers into a Complex Hearing Need Clinic with designated experienced staff members to improve the quality of experience and effectively meet patients needs in one visit. The development of a Complex Hearing Needs Network within North West SHA, following an on line survey of providers, enabled this tertiary centre to start to agree referral criteria and identify training needs and support for referring providers. Click HERE to find out how they set up network and clinic.
Transition of young people from Children’s Hearing to Adult Hearing Services – Redesigning pathways
NHS Devon and NDCS used a multidisciplinary approach, led by a steering group of a wide range of stakeholders to develop a new Children’s Hearing to Adult Hearing Service. The team sought the views of young people through five difference focus groups. Click HERE find out how they did it.
NHS Tower Hamlet and NHS City and Hackney developed an improved pathway which decreases the length of time between the last children’s service appointment and the first adult appointment, promoting the likelihood of attendance. Adult audiologist were trained on deaf awareness issues to support young people. Click HERE to find out more.
East Lancashire Hospitals used on-line questionnaire results to help shape a new pathway and improve the quality of information leaflets. To encourage longer term attendance in clinic audiologists were trained in new roles as ‘transition audiologists’ to improve communications and ongoing care between paediatric and adult department. Click HERE to find out more.
Redesign of Children’s Balance Pathways
Community based paediatric tier II level vestibular screening service
St. Georges Hospital, London introduced a tier II level vestibular screening service managed by a community based paediatrician, with specialist interest in audiology/vestibulometry, to allow more appropriate referrals to be seen in Audiovestibular Physician clinics. The new pathway allowed increased numbers of patients to be seen in the Consultant clinic. Click HERE to find out more.
Streamlining Children’s Balance pathways using Healthcare Scientist
Sheffield Children’s Hospital NHS Trust developed a clinical pathway that determined which patients required the input of an Audiovestibular Physician and which could be managed appropriately by a specially trained healthcare scientist. A DVD was developed to explain procedures to the parents/child to aid compliance during the test and reduce anxiety prior to testing. Click HERE to find out more.
Redesigning Children’s Hearing Services
Warwickshire Local Authority reviewed children’s hearing services across three acute trusts, a community service and the Local Authority. Gaps in service provision were identified and the skill mix of staff involved in pathway was evaluated. Redesign of the educational audiologists role allowed more time to support those children who require specialist intervention. The development of a virtual learning platform allowed children speedy access to help, information and support. Click HERE to find out how they did it.
South Tees Hospitals NHS Foundation Trust worked with health, education, social care and voluntary organisations, across five PCT localities, to understand current service provision for children with hearing loss and an ideal pathway was agreed. The concept of a ‘link worker’ role to act as a single point of contact to sign post parents to appropriate local services was developed. Click HERE to find our more.
Application of Service Improvement Tools and Techniques to improve the quality of Service and Reduce Patient waiting times
In 2008/9 NHS Improvement worked in partnership with the Department of Health National Audiology Programme, supporting a programme of service improvement, working with challenged sites. Using proven improvement methods, such as Lean methodology, this work has resulted in reduced waiting times, streamlined patient pathways and improvements to the quality of experiences for both patients and staff. For a summary report on work on challenged sites click HERE.
Transformation of Audiology Services via LEAN methodology
Since November 2008 Maidstone & Tunbridge Wells NHS Foundation Trust (MTW) clinical and management teams have been working hard to improve their Audiology services delivered to local patients. Engagement with the NHS Improvement Audiology Team, working alongside the Department of Health under Transforming Audiology Services (TAS), supported the MTW team in undertaking a series of improvements, including a Lean Improvement Event.
Following the Lean Improvement Event in February 2009, an action plan was formulated to instigate a variety of improvements within the two Audiology sites in the area. Subsequently steered by a newly formed Audiology Improvement Group within the Trust, work has systematically taken place over the last year to ensure the action plan was put into place, whilst evolving new actions were identified and added.
Success in MTW has been underpinned by strong executive support for the changes and a determination at all levels to bring about improvements to audiology services, many of which have been implemented quickly and without additional funding. Staff now feel more empowered to continue the cycle of improvement for the future.
CLICK HERE to read the MTW full report.
For further information contact: Femi Odewale at: b.odewale@nhs.net or Sarah Armstrong-Klein at: sarah.armstrong-klein@improvement.nhs.uk
