Patient Information: Setting up a new service
Pitfalls & Pluses
Paul Stevenson
Our Service
Signposting
• We do not produce new material.
• Signpost patients to appropriate existing high quality
services and information.
• Advice staff who are producing specific internal
patient information leaflets and products.
Quality Assured Information
• Certified source : Information Standard
• Assess using tool such as DISCERN
(www.discern.org.uk)
• Discuss with specific healthcare professionals
How do we deliver the service
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Web Site
Telephone
Email
In Person
• Work with wider community
• Work with internal staff
Web Site
We link to a lot of existing material
USP - Localisation
Access Routes
• Web Site is getting approximately 2,000 hits per
month.
• Difficulty in measuring what that actually means, or
the impact .
• Far more email enquiries than telephone or in
person enquiries. (approx 80% by email)
• Direct enquiry levels are still lower than we
anticipated: approx 8 per month.
Why Offer Face to Face and Telephone Enquiries
• We can spend longer with patients. Clinicians and
GPs often do not have sufficient time to discuss in
depth.
• Often not the patient but relative or carer who
wants the information.
• Often enquiry is prior to contact with a healthcare
professional.
Book Stock
• Fast Facts Series
• BMA : Understanding/ Family Doctor series
• Medical Dictionary/Encyclopaedia
• Good basic visual physiology and anatomy text
Setting Up The Service – Reflections
• Objectives and Aims
“We need a patient information Service”
– Difficult to get exact measurable objectives from
Executives.
– Cost savings through reducing re-admissions.
– Supporting long-term condition pathway.
Limitations we knew about in advance
• Budget
A few thousand pounds.
Limited scope for what service can do.
• Location
Within current healthcare library
Limited patient footfall or ‘drop in’ opportunities
• Staffing One full time member of staff
Limited outreach and community involvement work
• Patient Information Strategy I wrote one
Lacked clear specific objectives or outcomes
• IT
NHS block on social media and advanced web functions.
Enquiries – What we Expected
• General enquiries about specific conditions &
treatments
• The kind of thing that’s on NHS Choices:
Enquiries – What we Actually Get
• More orientated to local service provision:
“I’m claustrophobic, is your MRI scanner enclosed or
open?”
Layers of Enquiry
• Patient has bladder weakness
• Asked for information on “exercise at home” as
unable to go far or do vigorous exercise without
incontinence issues.
• Actually wanted information about dealing with
incontinence
Active Listening
• Sometimes people just want to be listened too…
Set Boundaries
Explicitly document what is expected of the service.
Will you give information that differs from local practice?
– i.e. Give details of a drug that is prohibitively expensive.
– i.e. Give details of a surgical technique that is not used in the local
hospital
– i.e. Give details of off-label drug use such as Avastin for AMD
www.rcpsych.ac.uk/pdf/General%20-201.45%20Staff%20%20Patient%20Boundaries%20%20Relationships_Ashen%20Hill%20East%20Sussex.pdf
– Code of Conduct / Professional Standards
– Is it OK to accept gifts of thanks ; or start friendships with patients
?
– What support should staff expect to be in place for them?
Setting Boundaries
•
Enquiry – woman wanted details of local private options for
abortion.
•
Was her 20th abortion , used as method of birth control.
How do you best answer this enquiry?
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•
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Do you supply the details requested
Give information on alternative methods of birth control
Is this a safeguarding adults issue – is there possibly an abusive scenario here?
Do your staff know there responsibility for safeguarding adults/children?
Setting Boundaries
• Enquiry –man wants details of European countries that offer
euthanasia.
How do you best answer this enquiry?
• Do you give the information requested ?
• Do you give information on palliative care and end of life planning ?
• Do you refuse to answer the enquiry stating referral to more expert
healthcare professionals is needed ?
– Counselling
– End of life /Palliative care team
Set Boundaries
Explicitly document what is expected of the
service.
– Information –vs- advice
– What depth
– Will you clarify the meaning in statistical data?
– Will you supply journal article/research level information?
– At what point do you ‘refer’ to other services ,
what is the referral process?
Good Governance
• Record patient enquiries
– Useful for service evaluation
– Evidence in any legal proceedings
– NHSLA
• Standard operational Procedures (SOP) & Guidelines
– Protects & supports staff delivering the service
– Indicates the level of service expected
– Gives patients consistency of service
What worked
• Email enquiries
• Specific Focus on local information and support
• Patient Information prescriptions & Integration with
care-pathways
• Starting small and gradually growing
What we would do differently
1. Establish clear objectives & outcomes
2. Identify physical location that is prominent and
easily accessible to patients.
3. Have SOP and guidelines in place prior to service
starting.
4. Ensure staff delivering service are confident and
have opportunities for training .
Further Information
• Contact me if you have any questions or want to visit
• Paul.Stevenson@anhst.nhs.uk