Better Outpatient Follow-up | i3 | institute for innovation + improvement

Outpatient follow-up appointments occur when patients are asked to return to hospital to have their progress checked, to undergo tests, or to get test results

Opportunity

Our outpatient services complete approximately 20,000 appointments each month; approximately 17,000 (70%) are follow up appointments. We do not have the capacity to see all patients currently being booked for outpatient follow-up clinics
Currently there are >25,000 overdue planned follow-up appointments and >22,000 already planned for the future that we do not have the capacity to see
Overdue follow-up appointments date back to 2011. Future follow-up appointments have been scheduled for as far ahead as 2029

Follow-up appointments have a significant impact on patients and their whānau including time off work; making child care arrangements; transport and parking costs; and waiting in clinics. Whilst some follow-up appointments are clinically required, a large proportion are unnecessary.

Planned appointments include patients awaiting test results who do not need a face-face follow-up appointment; and there are patients whose clinical note says ‘discharge’ but were not
Planned appointments are inconsistently managed and reviewed by each service, and there is insufficient information to prioritise and identify patients that do not actually need to be seen

Reducing unnecessary follow-up appointments will improve the experience of patients and their whānau and will increase our capacity to see new patient referrals.

Aim

We want to change how our clinicians approach outpatient follow-up appointments by streamlining and standardising appointments, considering alternatives to a consultant-led hospital-based outpatient appointment and applying innovative technologies.

We are aiming for:

effective and innovative outpatient services with the right patients being seen by the right people, at the right time and in the right place
patients and whānau have an excellent experience with outpatient follow up care

Intervention

i3 is leading a group of projects that are part of a larger, organisation-wide Outpatient and Elective Services Improvement Programme. The Programme includes 40 projects. There hae been two workshops held to prioritise projects and develop a "Future State Vision".

Outpatients and Elective Services Improvement Programme and Future State Vision

i3 is leading the following projects:

Development of an electronic outpatients data dashboard with Qlik Sense
Development and testing of a proof of concept electronic outpatients outcome form [View more]
Future outpatient clinic models of care and innovation including:

SOS appointments (patient-generated appointments)
Virtual appointments
Telehealth-enabled appointments
An on-line booking and kiosk system

Electronic outpatients data dashboard

Impact

	Attended Appointments		Attended Follow-Up
	Total	Mean	Total	Mean
2012	203,012	16,617	132,326	11,028
2013	215,453	17,954	141,181	11,765
2014	231,615	19,301	151,005	12,583
2015	242,578	20,214	158,635	13,219
2016	225,189	18,765	159,143	13,261
2017 (exc Jun)	226,754	20,614	145,194	13,264

12% increase in outpatient appointments and 10% increase in follow ups in last five fiscal years

We have developed an electronic outpatients dashboard that allows ‘drill down’ to individual patient and clinician level [link or picture]. Electronic outpatient outcomes will be incorporated in the dashboard once these are available. This will enable each service to prioritise patients, streamlining and standardising of appointments, and manage outpatient appointments in real-time.

We will update progress.