Case Study: Improving the Referral and Diagnostic pathway for Patients with New
Colorectal Symptoms across Tayside
What was the problem?
There were too many ways into the colorectal service, which resulted in inequity of access,
confusion and extreme variation in the management of the patient presenting with new
colorectal symptoms
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Inequity of Access
Too many ways into the Service
Confusion and extreme variation in patient management
There can be up to 200 days difference in time between presentation and surgical
management depending on which pathway the patient enters
Variation in clinical practice
Support Staff overwhelmed and Burdened by a paper system which was slow, prone
to error and introduced delays in patient management
S
What improvement tools were used?
A Rapid Improvement Event (RIE) using Lean methodology, was held from 23rd- 27th April
2007.
A multidisciplinary team of 19 people from Radiology, Endoscopy, Primary Care and NHS
Tayside Modernisation Team were freed from their work commitments and were facilitated
through the week by Ross International. Having been introduced to the principles of Lean
Methodology the team split into groups and visited the three sites in Tayside which receive
colorectal referrals. The process was examined from start to finish, mapping every step and any
problem experienced at each step. This was also an opportunity to speak to staff and patients
about their experiences.
A set of Team Goals was developed and the Team set to work designing solutions which were
subsequently discussed with staff at all three sites in order to obtain their views and acceptance
to the suggested changes.
An agreed 12-week action plan was developed allowing progression of the improvements
required to develop an enhanced colorectal pathway. Each member of the Team had
responsibility for a specific action point.
What is the situation now?
Protocol based referrals
Single route referral management
system
Combined same day
Flexible
Sigmoidoscopy / Barium Enema
service
across the three sites in
Tayside.
Daily screening of all referrals by a
team
of
Consultant
Medical
Gastroenterologists
Tracking of all referrals through the
pathway
Patient information at every stage.
Information and rapid dissemination of
results to General Practioners
Generic Tayside patient Information leaflets
for patients referred to the colorectal service
Standardised Operational Procedures and
consistent clinical practice at the point of
service delivery across Tayside
Daily screening of results with timeous
managed clinical decisions.
Co-ordinating the patient journey form start
to finish
Patient receives the right test, at the right
time, by the right person
NHS Tayside - time from receipt of referral to outcome of examination for
routine colorectal patients
Routine wait
Mean wait
180
160
140
Days
120
100
80
60
40
20
October - December 2007
October - December 2006
Date of receipt of referral
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What are the benefits to patients?
What are the benefits to staff?
Information at the point of referral
Information on receipt and screening of the
referral
Information on diagnosis and results
Information on cancer pathway
Journey happens in a timely fashion
Patient knows the length of wait
Patient less likely to get lost in the journey
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Less duplication of work
More patient centred environment
Less chasing of patient notes and
results
Ownership and pride in the new
process
Less disruption and interruptions
WHAT ARE THE BENEFITS TO THE ORGANISATION?
Improved efficiency and reducing waste
Clear patient pathway
Referrer informed of progress
Improved interface between Primary and Secondary care
More appropriate testing
Well informed Patients resulting in a reduction in complaints
KEY SUCCESS FACTORS
Strong Clinical Leadership.
Involvement of staff who know the process inside out
Passion and Commitment to Improve
Senior Management support gave the team the power to push harder and ensure the
sustainability of the changes.
WHAT WOULD WE DO DIFFERENTLY NEXT TIME?
Stick to the original aims and goals
Improved communication strategy
Ensure a good interface between Primary and Secondary care is vital
Ensure a good interface between secondary care clinicians and management
Further Information available from:
Jill Forbes, Endoscopy Services Manager
jillforbes@nhs.net
Dr Nigel Reynolds,
Consultant Gastroenterologist
nigel.reynolds @nhs.net
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