G55(P) The DNA dilemma: a qip to decrease inefficiency caused by dnas in community paediatrics outpatient clinics

Abstract

Background Community paediatrics clinics require considerable preparation time.1 Community paediatrics outpatient clinics have a high Did Not Attend (DNA) rate.2 Problem statement In community paediatrics, registrars spend time preparing for each clinic. When patients Do Not Attend, another registrar has to spend this time again preparing for their rebooked appointment – this is very frustrating. Aim To introduce a system where registrars can hand over paperwork they have created in preparation to see a patient who DNA their clinic appointment, to the registrar who will see that patient in their rebooked appointment, by the end of August 2018. Method A handover pro-forma was designed and introduced, to attach preparation work to, to be stored and used when another registrar sees that patient in their rebooked appointment. Over eight PDSA cycles, improvements were made to the pro-forms. Time spent on each clinic preparation activity was measured for the initial and rebooked appointment. Due to the long time period between the initial appointment that was DNA, and the rebooked appointment, preparation for the rebooked appointment was simulated soon after DNA. Preparation using the completed handover pro-forma was done as if patient was going to be seen in clinic imminently. Results Initially the handover pro-forma was not completed properly, and did not save any time. In later cycles the pro-forma took more time to complete, than time it saved. By the last cycle, the pro-forma was completed for 100% of DNA appointments eligible to be rebooked, and preparing for the rebooked appointment using the pro-forma took 50% of time that it took to prepare for the original appointment. Conclusions Trialling the handover pro-forma identified unexpected problems, improved through PDSA cycles. The pro-forma saved time preparing for rebooked clinic. Continued monitoring will be required to show whether this benefit is sustained over time. References Curtis E, Waterson T. Community paediatrics and change. Arch Dis Child 2002;86(4):227–229. Lakshminarayana I. G198(P)Measures to improve non attendance rates of community Paediatric Outpatient clinics. Arch Dis Child 2016;101:A106.