New outpatient management pathways at save estimated £1.3m
Shaping Change at Cardiff and Vale University Health Board (UHB) is currently undertaking a 100-working day sprint challenge, Empowering Outpatients, to increase the number of outpatients placed onto See-on-Symptoms (SOS) and Patient-Initiated Follow-up (PIFU) pathways.
Since the start of the sprint, which began in April 2023, Shaping Change have supported clinical teams to launch 25 new pathways and add an additional 4500 patients across all SOS and PIFU pathways.
NHS England data suggests that up to 1.8 unnecessary outpatient appointments are avoided per patient managed in this way1. Each outpatient appointment at Cardiff and Vale UHB costs approximately £160. Therefore, to date the sprint has saved an estimated £1.3m.
Further, we estimate that the amount of carbon saved from the reduction in patients travelling to appointments is 18.30 tonnes, which is the equivalent to planting 300 trees!
With more pathways in development and more patients expected to be managed this way in the future, SOS and PIFU are a clear way of making the outpatient follow-up appointment model more manageable for clinicians and much more sustainable.
What are SOS and PIFU?
SOS and PIFU pathways provide an alternative approach to follow-up appointments for people with short- and long-term conditions, respectively. Patients who are suitable for this approach will be empowered to initiate their own follow-up appointments as and when they need them, which might be after a flare-up of symptoms or a change in circumstances, for example, instead of being seen routinely in appointments they may not necessarily need.
For our clinical teams, working in this way releases time to see complex patients, patients waiting for an initial appointment, and patients who are 100% past their target date without an appointment booked. It also helps clinicians to manage their caseloads and waiting lists.
Feedback shows that these models of care lead to improved outcomes for patients, who can get appointments with their specialist team more easily outside of the usual routine follow-ups, as well as improved patient satisfaction as services are more responsive due to reduced waiting lists. They also reduce unneeded visits to hospital, which inevitably lead to high levels of “did not attend” (DNA) rates.
Following the COVID-19 pandemic, Welsh Government set an ambitious target to all Welsh Health Boards to manage at least 20% of all their outpatient follow-ups using these two pathways. With tens of thousands of outpatients being seen across dozens of specialities in one Health Board alone, implementing the use of SOS and PIFU was always going to be a challenge of scale.
Empowering Outpatients in Cardiff and Vale UHB: the story so far
In September 2021, members of the UHB Shaping Change team, alongside colleagues from its Operations team and representatives from Welsh Government came together to attend the Spread and Scale Academy.
Designed to support teams with innovative projects that are ready to spread so they can benefit as many people as possible, the academy helped identify the non-negotiable aspects of SOS and PIFU and many ways in which they could be scaled up and implemented across a complex system such as Cardiff and Vale UHB initially with a full-scale ambition across Wales.
Following attending the Spread and Scale Academy, the Shaping Change team worked alongside Welsh Government to develop a national website, Outpatients.wales, for clinical teams working across all Welsh Health Boards to access a range of resources to help them implement and effectively use the SOS and PIFU pathways in their areas, including criteria for identifying suitable patients, template letters, flow diagrams and more.
Additionally, working alongside digital colleagues in Cardiff and Vale UHB, the team set up an internal SOS and PIFU dashboard in order to visually present an overview of the progress made by the Health Board as well as individual specialities and allow clinicians to individually identify and track their patients on these pathways.
Across a range of specialities, Shaping Change worked to ensure that new codes for SOS and PIFU were available on patient management systems so that the process of placing patients on the pathways was as streamlined as possible.
With all these foundational pieces of work, the team decided they were ready to start implementing the pathways at scale, and at pace. In Spring 2023, they agreed to undertake a 100-working day sprint – on of the spread methodologies taught at the Spread and Scale Academy.
A dedicated team of improvement, project management and communication professionals undertook the challenge of meeting the Welsh Government target of 20% and have been busy engaging with services and specialities across Cardiff and Vale UHB to drive this important work forward, as well as organising directorate-specific workshops to support teams with their outpatient management and flow.
They are also working to re-develop the outpatient section of the Cardiff and Vale UHB website to ensure that patient information, including self-management guidance and relevant contact information, relating to these pathways is all easily accessible, understandable, standardised and correct.
With the end of the 100-working day sprint in their sights, the team are keen to capture and share what they have learnt throughout this process with colleagues across Wales, as well as get insight and feedback from different perspectives and have been an active member of Improvement Cymru’s Safe Care Collaborative.