CASE STUDY: Marie Loizides, Associate Director of Performance Analytics at Barking, Havering and Redbridge University Hospitals NHS Trust, outlines how North East London Musculoskeletal (MSK) Alliance significantly slashed waiting times by improving the quality of referrals.
Patients coming first is one of the core values underpinning the NHS. And so, we all want to do everything we can to get patients the care they need to improve their health and wellbeing as quickly as possible.
National strategies are already in place and share the common end goal of tackling the elective care backlog. They include country-wide initiatives such as reducing no-shows and eliminating waits of over 78 weeks to zero.
But much can be done on a local level too.
How we reduced patient waiting times
Referrals to our services run into the thousands. Patients with musculoskeletal (MSK) conditions and arthritis often self-manage their conditions in chronic pain. Long wait times for treatment can severely impact their physical and mental health.
Like many areas of the health service, our patients were experiencing a varying quality of care across the boroughs due to organisational boundaries and historical funding. Depending on where they lived, the time patients were waiting for physiotherapy ranged from six to more than 26 weeks. Our ambition was to change this by reducing the time between MSK referral and treatment.
And, although there is no single magic bullet, we’ve found automating triage has sped up the delivery of care and freed up both GPs and consultants’ time.
Reducing rejected MSK referrals
As a first step, we audited our referral process to see what might be causing delays in the system. As a result, we discovered that 3,000 referrals a year had been previously rejected because they were missing key clinical information.
If a referral is missing vital information, including diagnostic imagery, it can’t be processed quickly. It also makes it more likely that the patient will be sent to the wrong clinic. As a qualified physiotherapist, I’ve witnessed first-hand how a referral to the wrong clinician or for the wrong treatment can impact a patient.
We knew that the effect would be significant if we could prevent rejected referrals. For example, it would positively affect waiting times. And valuable appointment times would be filled with patients being seen by the right specialist the first time.
We decided to digitalise the referral process so that primary and secondary care could easily and securely share electronic patient data. The aim was to improve the quality of MSK referrals and keep patient wait times as short as possible.
Improving support for GPs
It also made sense to bring clinical decision-making into the GP surgery. So, with the help of NEC Rego, we developed a clinical algorithm to make our vision a reality.
An important first step in the process was to consult a wide range of practitioners and experts in patient care to set different treatment pathways. Stakeholders included GPs, primary care providers, hospital clinician consultants and physiotherapists.
We then developed and refined the AI algorithm to ensure the agreed treatment pathway was in place for each condition we treated.
The changes mean it’s now possible for GPs to fill in the referral form during their consultation with the patient. In the past, they had to hand the referral form to their admin teams. But now they are so quick and easy to complete that most GPs are filling them out there and then.
The algorithm prompts them with a series of questions to consider to ensure the patient is referred to the correct service for their needs, for example, a consultant or physiotherapist. Should more diagnostic tests be needed before a consultation with a specialist, the referral tool will prompt the GP to complete these, helping to prevent additional delays in accessing the correct care.
Accurate MSK referrals
The changes we introduced have been a gamechanger.
Now when a patient speaks to their GP about joint or neck pain, the doctor can view all their medical data alongside any prior input from the hospital team. As they have more information to hand, they can make a more informed decision regarding the best treatment options for their patient. The digital tool helps them do this by prompting them to ask the right questions.
Patients are no longer given appointments at the wrong clinic because the hospital triage team has already assessed the most appropriate service before scheduling the appointment. Accurate referrals have increased by 70% as a result, and there is a greater consistency of care for the patient.
The outcomes for MSK patients
Since we digitalised the MSK referral process, we have reduced patient waiting times by over a month because triaging cases now takes half the time. This means our patients are now receiving the treatment they need quicker, helping to reduce the strain on support services and other parts of the NHS.
It’s less stressful for staff too, as we’ve stopped firefighting. So, for example, we no longer have to find new appointments for incorrectly referred patients. That’s because using the correct referral to treatment pathway has resulted in a 50% reduction in consultant-to-consultant referrals within the trust.
Rethinking how we managed the MSK referral process has revolutionised patient care. It has helped reduce costs by ensuring the patient is seen by the right specialist the first time. And it has made it easier and quicker for referrals to go from primary to secondary care.