LEADING BETTER CARE Sharing Good Practice
St Andrews Community Hospital, Outpatients
Phototherapy is a relatively new service at St Andrews Community Hospital.
On moving to the new hospital in 2009 we carried out approximately 36
treatments per week. Now 3 years on we are carrying out in excess of 120
per week. Staffing levels have remained unchanged. Due to the increase in
service levels a waiting list started to develop which was gradually
increasing and it was at this time I decided to develop a business plan in a
bid for extra staff. Around this time it had also been highlighted that DNA
rates in dermatology in particular phototherapy were one of the highest in
the area.
It was felt by reducing the DNA rates appointment times could be freed
up to address the waiting list. This work was carried out over a 6 month
period
The safe maximum number of patients being treated in phototherapy at
any one time with the present staff had been set at 45 following discussions
with consultants.
Various factors were looked at including age, gender, demographics,
appointing and discharge procedures. I visited other areas with a similar
service to observe their working ways.
A patient attends 3 times per week for treatment .If a patient DNA’s for 1
week this is recorded as 3 DNA’s Hence the DNA rate can be shown as quite
high if only 3-4 patients DNA in 1 week i.e. 9-12 DNA’s would be recorded.
St Andrews is different to other areas due to the high student
population. Patients often go away home for weeks during breaks at
university. A semester timetable has been obtained from the university.
Students are now booked in during their term times where possible. Also
we try not to appoint before 10 am and afternoons due to study
commitments.
Previously if a patient DNA’d for 2 weeks they would be sent a letter
asking them to contact the department. Following a further week they
would then be discharged back to their GP. Paper work has now been
streamlined and patients are asked to sign a consent/disclaimer stating
they understand and agree after 3 DNA’s they are referred back to their GP.
Staff are also encouraged to be more active i.e. phoning patient after 2
DNA’s and not booking further appointments. Guidance has been taken
from the NHS Fife Patient Access Policy
Several audits were carried out to ascertain the main reason a person
would DNA and preferred opening times. These highlighted a preference to
later or earlier appointments both are unavailable at present due to
staffing.
A profile of demand was also carried out to look at skill mix. At the start
of this project a band 5 was responsible for appointing, discharging, and
paperwork, inputting all computer information, stocking, ordering, and
cleaning. A band 3 HCSW has now been trained to help with this work.
DNA rates are now down from 13.7% to 11.7% which is reports as very
significant and the target for new outpatient DNA’s is at it lowest 7.5%
(target is 7.8%).
Patients are now able to access appointments sooner, regular
attendance results in faster improvement in skin conditions improving
patients’ morale. Length of treatment is reduced with regular attendance.
Staff morale has improved. Time is utilised more efficiently. Waiting times
are reduced.
More work is planned including the possibility is setting up SMS text
reminder system.
Contact Information
Sharon Serjeant,
Charge Nurse,OPD/MIU/Dermatology/Treatment Room,
St Andrews Community Hospital,
Largo Road,
St Andrews
KY16 OHP
01334 465719
01334 465720