Patient Choice Booking Project Jacinta Opie Project Manager 26th November 2013

Specialist Clinics Austin Health • Specialist Clinics (formerly known as Outpatient

Department) is a consultative-based health service, incorporating teaching, training, research and minor procedures for clients from the community and non-bed based hospital patients.

• 221,645 patients attended Specialist Clinics in 2012

• The department is located across two campuses – Heidelberg Repatriation Hospital – Austin Hospital (4 sites, 5th site opening January 2014)

Specialist Clinics Austin Health • Specialist Clinics are located on;

– Level 3 Lance Townsend Building, Austin Hospital – Level 3 Olivia Newton-John Cancer & Wellness

Centre (ONJCWC), Austin Hospital – Ground Floor,Tobruk Building, Heidelberg

Repatriation Hospital – Level 2, Centaur Building, Heidelberg Repatriation

Hospital – Level 4, Centaur Building, Heidelberg Repatriation

Hospital (opening January 2014)

What is Patient Choice Booking (PCB)? • It is an appointment scheduling system and waiting list

which allows patients to be treated in turn and in the time frame required.

“A better way for outpatient appointments”

Background • The partial booking (PB) outpatient appointment system

was introduced by the UK Department of Health in 1999.

• NHS targeted outpatient appointment waiting times of over 13 weeks.

• With PB, patients have the opportunity to choose a convenient outpatient appointment date. Failure to do so results in automatic removal from the PB system, with no appointment issued.

Wong S.C., Chang L. & Lee N. 2003 , Partial booking is it flawed?, Quality in Primary Care, Vol. 11 No 2, pp 117-122(6)

Background • The Royal Adelaide Hospital first introduced Partial Booking

(PB) for new appointments in 2006.

• Several Victorian hospitals have introduced PB for new appointment types.

• Austin Health completed project scoping in June 2010 & February 2011 application was approved 2012.

• Patient Choice Booking project commenced November 2012 incorporating new and review appointment types.

Why change booking systems? • Patient Focused.

• Creates better access for patients.

• Department of Health have established a new Access Policy to Specialist Clinics.

• New Key performance indicators (KPI’s) Austin Health are required to meet.

• We needed a better system.

What are the benefits of PCB • Better access to Specialist Clinics as we are not

booking appointments two years in advance.

• Patients treated in turn.

• Establish waiting list to even out demand.

• Reduce patient overbooking's to the clinics.

• Reduce patients that fail to arrive for an appointment.

• Reduce “re-do” work by clerical staff.

• Gives patients a choice about their appointments.

Old booking system • Future clinics booked 2 years in advance.

• Incorporates both new and review appointment types.

• Urgent patients must be overbooked into clinics as slots are filled ahead of time with non urgent patients.

• Frequent rescheduling of appointments to try and control numbers.

• Poor clinician leave notification resulting in rescheduling of appointments.

Old booking system • Rescheduled patients are rebooked out of order as future

clinics are fully booked.

• Patient had no choice in the appointment date or time just sent an appointment, resulting in rescheduling of appointments.

• High rate of patients that failed to arrive for an appointment due to being booked so far in advance.

• Patient flow varied with demand

• Communication with GP on receipt of referral.

New booking system • Future appointments are booked only 4 weeks in

advance.

• Incorporates both new and review appointment types.

• All urgent patients are booked as requested through the use of quarantine slots.

• Patients are sent an offer letter when an appointment is available.

• Patient telephone the Specialist Clinics call centre to make the appointment. Choosing a date and time that suits them.

New booking system • Separate waiting list for new and review appointments.

• The waiting list is used to control and even flow reducing queuing

• Offer of appointments are withheld if clinics are heavily booked

• Non urgent patients are booked according to how long they have been on the waiting list.

• Poor clinician leave notification resulting in rescheduling of appointments.

• Patients no longer requiring their appointment usually do not respond to offer letters.

• Improved communication with GP’s.

New Patient work flow

Central referrals

Referral registered

placed on WL

Sent to unit for triage

Outcome entered on WL

Urgent 1-4 weeks

Routine treat in turn

Appointment made

Placed on WL treat in turn

Implementation of PCB • Before implementation of PCB

– Development of software/hardware – Personnel – Training/education – developed online training

module – Infrastructure changes to Specialist Clinics – Post implementation review

• PCB Went live 6th May 2013.

• The first impact of PCB was seen in June 2013.

Implementation of PCB • Phase one: 500 clinics managed by Specialist Clinics

• 49,000 future appointments were cancelled and converted to PCB.

• A letter was sent to all these patients informing them of new booking system.

• Patient were also contacted by phone informing them their future appointment was cancelled.

• A PCB hotline was established.

• Increased staffing to the call centre.

Results

Results

Results

ENT – Activity

ENT - Activity

ENT - Activity

Outpatients to Elective Surgery • Improved access to outpatients has had a flow on effect to

the elective surgery waiting list.

• Data is available to drive change and improve access to Specialist Clinics.

• Ability to target units to change clinic templates to improve service.

• Allows better access to patients.

• Reduced waiting times for initial assessment.

• Patients placed on elective surgery waiting list faster.

Where to from here? • Fix software issues with PCB

• Implement online training module

• Monitor activity

• Formal evaluation of PCB will occur early 2014

• Implement phase two of project to incorporate satellite clinics and allied health clinics. (approx. 1000 clinics)

• Continue to drive change to allow patients better access to the outpatient department.

Thank – You

Any Questions?