Adult spine services

The adult spine service at St Thomas’ Hospital was previously an inefficient performer with patients waiting an average of nine weeks before being contacted following a referral. Nearly a third had their appointments changed for a later date, and 200 patients at any one time were waiting to be given an appointment.

Typical patients included those with prolapsed discs, spinal injuries and back pain.

In a pilot approach, the multi-professional team were taken “off-line” for a week – with no normal duties - during which they worked together with business consultants to design a more efficient referral process that removed waste.

Once completed, an implementation week took place one month later where the consultants, physiotherapists, admin and imaging staff all began to use the new system.

The changes included opening a spine service “cell” or workplace where all activities such as registering patients, screening referrals, requesting imaging and appointments were co-located. Physiotherapists now take an initial look at all referrals to decide the most appropriate treatment pathway. A whiteboard was introduced to identify exact clinic capacity over the next six weeks to enable staff to match this with the patient demand.

An appointment centre officer was appointed to manage patient appointments and these are now booked over the phone to reduce the number of patients who do not attend.

The results have been remarkable with patients now contacted by the department within five days, doctors are seeing 11 extra patients a week (a 42 per cent increase), only a handful or patients are waiting to be given an appointment, fewer appointments are being rescheduled by the hospital and the DNA rate has dropped by nearly half.

By enabling more patients to be seen the department is also able to generate extra income.

Mr Jonathan Lucas, consultant orthopaedic surgeon, said: “This entire process has been highly motivating and incredibly rewarding. By taking us off-line for the week we were given the time to explore what was going wrong and given the tools with which to put it right.

“I think before there was an attitude that maybe the delays were someone else’s fault. But by coming together we all were able to understand each other’s roles and how the things we did affected someone else, and how they affected how the patient was given an appointment. By doing this we were able to transform a service in which we are now seeing more patients and in a dramatically shorter time-frame in a manner that seemed inconceivable when we started. 

“All the staff have a great sense of achievement for what is now a fantastic service that is also sustainable into the future. “

David Grant, a change agent for the trust, said: “The team has been determined to make the changes they designed a reality, through discipline, focus and sheer hard work. They have shown that by taking time out to really understand their processes and by working together on improving them they can make a huge difference to the service their patients receive.”