Clinical Prioritisation Criteria (CPC) Project

Transcription

1 Clinical Operations Strategy Implementation Clinical Prioritisation Criteria (CPC) Project Clinical Prioritisation Criteria (CPC) Project Mike Hamilton: Suzanne Watling: Project Sponsor: GPLO MNHHS Project Officer MNHHS Dr Liz Whiting V1.1 March 2017

2 Clinical Prioritisation Criteria Clinical Prioritisation Criteria (CPC) are clinical decision support tools to help ensure patients are assessed in order of clinical urgency. CPC will be used by; 1. Referring Practitioners when referring patients to specialist outpatient services and 2. Specialist Outpatient Services when determining how quickly the patient should be seen (urgency category). V1.1 03/2017 2

3 MNHHS CPC project Aim of the project Encourage improved referral quality Increase utilisation of CPC to accept and categorise initial external referrals Reduction of referrals accepted with insufficient information/ do not meet clinical criteria Standardise GP communication regarding referral non acceptance e.g. insufficient information CPC used as business as usual to accept and categorise external referrals V1.1 03/2017 3

4 MNHHS CPC Project In Scope Out of Scope Initial external referrals received into MN Specialist Outpatients Categorisation of referrals using CPC Paediatrics Internal referrals Retrospective application of CPC to categorised referrals, subsequent referrals, amended referrals and referral continuation Elective surgery urgency categorisation V1.1 03/2017 4

5 CPC Project Phases Phase 1 (1 st July st December 2016) ENT Gastroenterology Neurology Neurosurgery Ophthalmology Plastics & Reconstructive Surgery Vascular Hepatology General Surgery Phase 2 (1 st January June 2017) Gynaecology Orthopaedics Urology V1.1 03/2017 5

6 Referring Practitioner Satisfaction CPC GP survey provided an insight in GP understanding and Satisfaction regarding current referral processes - GP surveyed happy to use referral guidelines - Approx. ½ GP surveyed do not currently use guidelines - Mixed responses around usability and access to existing guidelines - GPs felt they lacked information to share with their patients about Specialist outpatient referral requirements V1.1 03/2017 6

7 Specialist Outpatient Satisfaction CPC Resources V1.1 03/2017 7

8 Extent to which CPC Guidelines are being used V1.1 03/2017 8

9 Perceived Benefits from CPC V1.1 03/2017 9

10 Pre and Post Implementation Audit Methodology Pre-Implementation 1 weeks referrals (22 nd -26 th Aug 2016) Post-Implementation 1 weeks referrals (31 st Oct-4 th Nov 2016) Inclusion and exclusion criteria Audit GPLO used CPC audit tool to assess each referral V1.1 03/

11 CPC Audit Tool V1.1 03/

12 CPC Audit Tool V1.1 03/

13 CPC Audit Tool V1.1 03/

14 CPC Audit Tool Where different categorisation has taken place the GPLO will record this as well as the potential reasons for the variation - (e.g. clinical override). Free text information will include which CPC tests/investigations are commonly omitted by referring practitioners. V1.1 03/

15 Categorised without all Essential Information V1.1 03/

16 % of Up-Categorisation according to Specialty V1.1 03/

17 Pre and Post Implementation Comparison All Essential Information V1.1 03/

18 Pre and Post Implementation Comparison Does not contain all Essential Information V1.1 03/

19 Clinician Concerns Sending referrals back for more information Safety Issue for patient Clinicians Medicolegal responsibilities Long Waits Significant effect on assigned category Cancer sensitive specialties Less information + potential sinister cause = up categorisation V1.1 03/

20 Clinician Concerns Potential Solutions System tracking of rejected referrals and follow up Support of clinicians decision making by executive (following of CPC could be a pre-requisite of support) Clear picture of medico-legal responsibilities V1.1 03/

21 Current State Phase 2 implementation is underway Post implementation follow-up audits of phase 1 specialities Phase 2 pre implementation audit underway Larger sample size than phase 1 (improves power and relevance of audit) Site specific audits (all phase 2 specialities are multi-site) V1.1 03/

22 Questions? CPC Contact Details: Nicole Mitchell (PM) Smira Mokar Suzanne Watling Holly Teare Dr Mike Hamilton V1.1 03/