Service Improvement Programme Research Articles

The Relation between Flow Map Analysis and Residential Density Conditions in Sleman Regency, Special Region of Yogyakarta

The government of Sleman Regency has been seriously implementing the Smart Living concept under the Smart Regency idea. It is demonstrated by the achievements of the Transport Service Improvement Program in the form of developing type C terminal facilities, creating a transport licensing management information system, and data collection on public transport, types, number of modes, routes and route mapping. However, the affordability and availability of public transportation access in all government facilities (such as hospitals, schools and offices) as well as the integration of routes has not yet been fully realized. In order to support the identification of problems in the implementation of routes that should be integrated with residential areas, this research describe the relation between flow map analysis and residential density condition in Sleman Regency based on data respondent who has been living in Sleman Regency. The analysis was conducted by using quantitative method, especially using the ArcGIS as the analysis tool. Research data were collected through interviews, questionnaire distribution, observation which distribute all over the regency. The results showed that the current form of movement patterns originates from residential area that have high density (in terms of population), but not all of them are served by the existing transport public routes. The mapping results showed that although the majority of movement patterns are still operating in main service areas such as in the Yogyakarta Urban Area, however, there are still many areas that are not yet served, such as Kapanewon Moyudan, Minggir, Seyegan, Tempel, Turi, even Sleman as the administrative capital of Sleman Regency.

Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success

BackgroundCrisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place.MethodsManagers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis.FindingsA majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a ‘bigger whole’ was valuable.ConclusionCRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.

Kualitas Peningkatan Pelayanan Publik Menuju Aparatur Sipil Negara (ASN) Bertaraf Internasional

The purpose of this research is to examine initiatives to enhance the quality of public services. in order to achieve service standards that are on par with international standards for the State Civil Apparatus (ASN). This study employs a qualitative method with a case study at a local government agency. that has been recognized as the agency with the best quality public services. In-depth interviews with government officials were used to acquire data., employees and customers, as well as analisis of documents related to the implemented public service improvement program. According to the study's findings, local government agencies have succeeded in improving the quality of public services by implementing a number of strategic initiatives and programs. Among them are the effective use of information technology to improve efficiency and effectiveness accessibility of public services, training and human resource development to improve employee skills and professionalism, and implementing strict service standards to measure and ensure customer satisfaction. In an effort to achieve international civil state standards (ASN), local government agencies have set several main goals, including improving communication and speaking foreign languages, mastery of advanced public information technology and application of ethics and integrity in public administration. serve. function. service assignment. In addition, international recognition ISO (International Organization for Standardization) and others awards for quality of public services are successful goals pursued by these bodies.

Reduction in cycle time for a rapid polymerase chain reaction diagnostic test at the point of care

Rapid testing facilitates safe and effective diagnosis, but the true speed of the process is the time from collection of a sample to delivery of an accurate and reliable test result - 'end-to-end' time. Transport, unpacking and relaying of information can extend this time considerably beyond the minimum laboratory turnaround times as stipulated by PCR testing protocols. This study aimed to minimise time needed to ascertain SARS-CoV-2 status prior to treatment in a UK Dental Hospital using a novel, mobile, direct to polymerase chain reaction (PCR) workflow. Process flow analysis and PDSA (Plan, Do, Study, Act) cycles for rapid continuous improvement were employed in a service improvement programme. Primerdesign™ q16 rapid PCR instruments and PROmate® COVID-19 direct assays were used for molecular testing. We showed a reduction in real-world end-to-end time for a diagnostic test from 240min to 85min (65% reduction) over a 4-week period. New rapid technologies have become available that reduce analytical time to under 90min, but the real-world clinical implementation of the test requires a fully integrated workflow from clinic to reporting.

Symptom clusters in chronic kidney disease and their association with people's ability to perform usual activities.

People living with a long-term condition, such as chronic kidney disease (CKD), often suffer from multiple symptoms simultaneously, making symptom management challenging. This study aimed to identify symptom clusters in adults with CKD across treatment groups and investigate their association with people's ability to perform their usual activities. We conducted a secondary analysis of both cross-sectional and longitudinal data collected as part of a national service improvement programme in 14 kidney centres in England, UK. This data included symptom severity (17 items, POS-S Renal) and the extent to which people had problems performing their usual activities (single item, EQ-5D-5L). We categorised data by treatment group: haemodialysis (n = 1,462), transplantation (n = 866), peritoneal dialysis (n = 127), or CKD without kidney replacement therapy (CKD non-KRT; n = 684). We used principal component analysis to identify symptom clusters per treatment group, and proportional odds models to assess the association between clusters and usual activities. Overall, clusters related to: lack of energy and mobility; gastrointestinal; skin; and mental health. Across groups, the 'lack of energy and mobility' clusters were associated with having problems with usual activities, with odds ratios (OR) ranging between 1.24 (95% confidence interval [CI], 1.21-1.57) for haemodialysis and 1.56 for peritoneal dialysis (95% CI, 1.28-1.90). This association was confirmed longitudinally in haemodialysis (n = 399) and transplant (n = 249) subgroups. Our findings suggest that healthcare professionals should consider routinely assessing symptoms in the 'lack of energy & mobility' cluster in all people with CKD, regardless of whether they volunteer this information; not addressing these symptoms is likely to be related to them having problems with performing usual activities. Future studies should explore why symptoms within clusters commonly co-occur and how they interrelate. This will inform the development of cluster-level symptom management interventions with enhanced potential to improve outcomes for people with CKD.

Implementation of child mental health service improvement plans in four low- and middle-income countries: stakeholders’ perspectives

ABSTRACT Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants’ priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level.

PhysioNow – A digital musculoskeletal patient self-assessment application, transforming access to MSK physiotherapy services

Keywords: Digital; Transformation; Quality Purpose: PhysioNow is a digital self-assessment application that was collaboratively developed by Connect Health and EQL. The main aims of introducing this technology were to:(1)Improve patient access pathways(2)Utilise digital triage to stratify patients, allowing urgent clinical conditions to be picked up rapidly and directed to appropriate care(3)Work towards recommendations of the TOPOL report and the NHS five-year forward view around digital healthcare(4)Reduce administrative processing time(5)Provide information to improve the quality and focus of clinical consultations Methods: PhysioNow was co-produced by digital and clinical colleagues as informed by an EIA through an innovative service improvement programme. An AGILE approach was adopted within implementation, working in sprints to ensure all components were met. Process design was applied to use robotic process automation (RPA) in both registration of patients and handling of patients in the clinical system following PhysioNow completion, additionally the linking of our data warehouse to the registration portal and web application via an Application Programming Interface (API) allowed seamless patient transition and information flow. Time was invested developing the clinical decision tree algorithms to ensure patients were asked appropriate questions and stratified safely, in line with normal volumes of red flags/urgent cases. Decision tree changes involved clinician feedback and clinical audit of all patients’ outcomes to continually improve the decision tree. Patient focus groups were employed to look at specific questions and all patients that used PhysioNow were involved in service user feedback. Results: Between July 2020 and the 14th of April 2021 PhysioNow was transitioned in a phased approach to 15 NHS physiotherapy services. To date, 22,422 patients were eligible to use PhysioNow and 96% were offered the opportunity to complete it. 15,366 patients have subsequently completed, with an uptake of 73%. 11,219 patients have been stratified to routine care, 3393 patients were stratified to an urgent physiotherapy assessment, 487 patients were advised to seek advice of NHS 111. Benefits achieved are an accessible platform for patients available 24/7; patient access and improved patient journey, clinicians effectively using PhysioNow outputs to target and inform clinical assessment; improved waiting times; reduction in volume of admin registrations via RPA has led to financial savings. Conclusion(s): This programme of work has enabled Connect Health to deliver a safe, effective, cost neutral solution to stratification of patients referred to Community MSK Physiotherapy services. We have demonstrated high levels of patient uptake by adopting an AGILE delivery cycle and identified barriers to clinical effectiveness and user accessibility/digital literacy via Continuous Improvement. Plans include further stratification of clinical conditions, enabling direct referral from PhysioNow into a supported self-management environment along with using AI and machine learning, to enhance the decision tree and pathways. Impact: This project has been implemented into routine practice across Connect Health, providing patients with a new accessible way of accessing MSK physiotherapy services. PhysioNow has been trialled with Welsh Health Boards to support Covid Recovery successful and demonstrates enhanced patient care pathways, clinician interactions and effectively detects clinically urgent conditions that needed urgent care. Funding acknowledgements: This work was funded by Connect Health and EQL as the Healthcare provider and the technology develop respectively.

29P All Wales Medical Genomics Service: Implementation of a comprehensive DNA and RNA next generation sequencing panel to transform Welsh cancer diagnostics for solid and haematological cancers

The All Wales Medical Genomics Service (AWMGS) provides cancer genomic testing (solid tumours and haematological cancers) to all NHS Wales Health Boards, serving a population of 3.5 million people, using multiple NGS panels and a range of other genomic assays e.g. FISH, ddPCR. As part of a continuous service improvement programme, the existing testing strategy was evaluated and a redesign was proposed to enable standardisation of the technical and analysis pathways, ensuring scalability and futureproofing of this rapidly expanding service.

BMJ Leader 10 minutes with Rosie Benneyworth

### Biography DR ROSIE BENNEYWORTH BM BS BMedSci MRCP Chief Inspector of Primary Medical Services and Integrated Care Care Quality Commission Rosie joined the Care Quality Commission in March 2019...

Report on Hotel Revenue and IHG’s Improvement Plan during COVID-19

This report examines the impact of COVID-19 on hotel industries and their management adaptations through the example of an IHG brand hotel. By presenting and analyzing the hotel’s data of 2020, a trend of noticeable decrease in booking and room revenue can be found. This report also illustrates the hotel’s service improvement program, which is used to counter such decrease in its revenues.

Implementation Of Birth Certificate Issuance Service Improvement Program (A Study of Permendagri No. 9 of 2016 in the Population and Civil Registration Office)

This study aims to analyze the implementation of a program to improve birth certificate issuance services at the Population and Civil Registration Office in Madiun Regency as a mandate from Permendagri No. 9 of 2016 concerning the Acceleration of Increasing the Coverage of Birth Certificate Ownership and to know the supporting and inhibiting factors. The author uses the indicator component of PermenPAN-RB No. 38 of 2012 concerning guidelines for evaluating public service performance. The results showed that one out of three excellent programs have not yet been felt beneficial. Based on analysis of PermenPAN-RB Regulation No.38 of 2012, there are six of nine indicators in the study results that were not run optimally. Supporting factors include budget, government support, and collaboration with village officials. The inhibiting factors are geographical location, human resources, communication/coordination, community awareness, semi-online services, data management, and population event reports at the village level

Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review.

IntroductionThe sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations.ObjectivesWe aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions.DesignSystematic integrative review.MethodsWe searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011–March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker’s Quality Assessment Tool was applied to included studies.ResultsOf the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1–2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability.ConclusionsThe body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.

Report on the impact of a service improvement programme in a well-established radiologically inserted gastrostomy service.

The present study aimed to evaluate whether the implementation of a service improvement programme improved the occurrence of radiologically inserted gastrostomy (RIG) tube displacements, post-insertion. A retrospective observational study of cancer patients was conducted over a 2-year period divided into two time points. Eighty-two RIG insertions were audited retrospectively; 42 in Time 1 and 40 in Time 2. Some 70% (n=57) of patients had head and neck (H&N) malignancy, 24% (n=20) had gastrointestinal cancer and 6% (n=5) had a variety of other malignancies. Following the implementation of the service improvement programme, the number of RIG tube displacements almost halved from nine (21%) to five (12%). The present study offers persuasive evidence indicating that the implemented service improvement programme improved patient care; however, further research incorporating a more robust evaluation is necessary. People with advanced disease are living longer and so there is a need to maintain good nutritional support. This innovation offers the potential to enhance patients' quality of care and minimise complications.

Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London

BackgroundEarly identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease.The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice.MethodsWe describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices.ResultsPrior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices.Conclusions‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.

Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs

Background Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high. Aims The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support. Methods Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up. Results Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes. Limitations Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements. Conclusions The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care. Study registration The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048. Funding The National Institute for Health Research Programme Grants for Applied Research programme.

The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial.

Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. To evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.

Embedding the patient during a service improvement programme in a healthcare system. Making beds in the NHS

An introduction comprising background and problem statement: There is a wide range of research into Patient Participation PP in healthcare 1, 2. However, certain areas of patient co-designed care remain under researched. One such area is organizational service delivery systems and models 2. While PP in organizational change management in healthcare remains almost unexplored. Unique access to an English Foundation Trust’s Lean service improvement programme SIP, enabled research which looks at whether/how the delivery of organizational change management in healthcare can be co-designed with the patient. Adopting the integrated care components of ‘Vision holistic perspective, organization and governance’ 3 the research captures tensions involved in fully involving the patient in their own care. Theory/Methods: Tensions in power, rationality and accountability/responsibility, examine and explain the patient’s role in the SIP. Ethnography empirically captures data relating to these tensions. Critical Action Research situates the research in the Trust’s organizational discourse. Results: To date the research offers dual insights into PP in organizational change management. Firstly, coterminous themes have been identified between PP and Lean theory which suggest existing organizational change management practices in healthcare are concomitant with theories of integrated care. Waste and value in systems efficiency; knowledge and perspective in strategy development; and organizational and healthcare boundaries, the traditional divide between roles and voice in co-designing care. Next, research into the patient’s role as a change agent in Lean organizational change management, suggests possible new Lean practices in healthcare, which work around patient participation. Discussions: PP in healthcare is already well established 1. Moral 4, 5, consequentialist 4, 6, epistemological and ontological 4, 6 and historical 7 perspectives and approaches have all been explored. Greater PP in their own care has a positive effect on patient 8 and organizational 6 outcomes. However, research into PP in healthcare organizational change management identifies further interesting areas of tension. Including the manifestation of coterminous themes and the boundaries organizational change management. Perspectives on the research’s theoretical rigour, place within the integrated care framework, limits and possible future research, will be discussed. Conclusions comprising key findings: For progress on integrated care aims the tensions between PP and organizational change management need to be explored and reconciled. For example, patient perspective, experience, specificity and voice may achieve healthcare improvements through contextual clarity and coherence of care. But the aim of zero-defect operating manifest in the SIP and patient safety goals to which healthcare organizational income is related, place these two positions at odds. This raises ontological and epistemological questions. Such as who or what structures drive patient service delivery outcomes power, who should make decisions on strategy development rationality and who or what is responsible for poor system efficiency responsibility and accountability. Suggestions for future research: Exploring capacities within care organisations to provide double-loop learning process redesign or deutero-learning learning to learn. 2; Overcoming barriers and integrating facilitators in cross-disciplinary groups 9 Orchestrating wider local governance which encompasses people’s integrative needs and perspectives 3

Improving Efficiency and Quality of the Children\u2019s ASD Diagnostic Pathway: Lessons Learned from Practice

The ‘autism diagnosis crisis’ and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline standards. This study reports statistically significant reductions in waiting times for autism diagnostic assessment following a children’s health service improvement programme. The average wait between referral and first appointment reduced from 14.2 to 10.4 weeks (t(21) = 4.3, p < 0.05) and between referral and diagnosis shared, reduced from 270 to 122.5 days, (t(20) = 5.5, p < 0.05). The proportion of girls identified increased from 5.6 to 2.7:1. Methods reported include: local improvement action planning; evidence based pathways; systematic clinical data gathering and a training plan. This is a highly significant finding for many health services wrestling with the challenges of demand and capacity for autism diagnosis and assessment.

Effective implementation of a patient blood management programme for platelets

To implement a patient blood management (PBM) programme in platelet transfusion. To improve the appropriate use of blood components, reduce wastage and generate savings. PBM is a multidisciplinary, evidence-based approach to optimising the care of patients who need blood transfusion and to use blood products appropriately. Strategies for PBM ensure that patients receive the best possible treatment with the transfusion of components when indicated, at the same time avoiding or reducing unnecessary transfusions. Typically, PBM initiatives have addressed the use of red cells. PBM initiatives in platelets (PBM-P) are an important aspect of Transfusion Medicine. We present data from an initiative for PBM-platelets (PBM-P) comprising a service improvement programme through the role of a 'platelet co-ordinator' (PBM-Pc) to optimise the use of platelets in a large complex tertiary care hospital in a National Health Service (NHS) setting. Analysis at 18 months of the role showed sustained improvement in compliance with quality standards defined by British Committee for Standards in Haematology (BCSH) guidelines and significant financial savings due to improved use and reduced wastage. The appropriate use of platelets increased by 17, 23 and 18% in the prophylactic, pre-procedure and peri-procedure categories, respectively. Importantly, despite concurrent increases of patient activity, platelet issues and cost reduced by 21% over the period of analysis. Our model has been efficacious in delivering the effective stewardship of platelets and can be successfully implemented in NHS.

Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis

ObjectivesTo determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an...