Digital referral system to improve patient access to renal services

Salford Royal Hospital houses the Northern Care Alliance NHS Foundation Trust's renal department. It serves 1.5 million patients across 6 different sites.

In general, inpatient consultation requests for renal services come from within the Trust. They also come from regional acute hospitals within the service catchment area.

Most of these requests come from areas with high acute levels, like:

• intensive therapy units
• admission wards

Before 2017, requests were made by pager via the switchboard. The specialist would then call the requester back to discuss their request.

Half of requests to on-call registrars came from other hospitals.

The type of requests for consultation were similar across internal or external requests.

In general, requests peaked around 3pm which aligns with blood results being returned around 2pm. This meant calls were held in a queue and referring clinicians lost a lot of time.

Situation

The Trust’s renal department received 35 calls a day. Each of these took an average of 9 minutes to resolve and document. This equated to a full-time role of an experienced member of staff to answer the phone.

This huge use of resources prompted the Trust to optimise consultation requests for specialist advice.

Aspiration

The Trust wanted to introduce an online platform to improve patient access.

They wanted to:

• reduce delays in responding to telephone enquiries
• reduce the amount of time referring sites have to spend on the phone
• improve workflow and job experience for staff
• standardise and share documentation across all 6 sites supported by the Trust’s renal service
• provide visibility and transparency in the patient transfer list across all sites

Solution

The Trust implemented Patient Pass in late 2016.

Patient Pass is a cloud-based consultation and referral management platform. It manages the inpatient consultation requests the Trust receives.

The platform improves communication between hospitals and specialist departments. It speeds up referrals, supports the reliability of clinical processes and gives a full audit trail for information governance.

Patient Pass improves patient safety, department efficiency and staff satisfaction.

The Trust’s renal service piloted this as part of the Global Digital Exemplar Programme. It’s now used by multiple tertiary services to coordinate care between sites.

The north sector of Greater Manchester used a renal referral system to provide:

• a quick way to get advice from specialist teams
• control of workflow by enabling asynchronous communication
• consistent, shared documentation between spoke and hub sites
• decision support to standardise advice and guidance
• transparent transfer lists
• real-time audits

Patient Pass has been rolled out regionally. All referring sites now use the system.

Impact

Feedback has been positive and the system is already freeing up staff time and improving patient experience. It's had an impact in multiple areas.

Communication has improved. Staff who are referring a patient can get status updates and can use the communication tool to ask questions. This has improved access to specialist renal advice for referring sites.

The specialist team is now more efficient because there are fewer phone calls. This has increased local care delivery and led to greater staff satisfaction.

Staff have increased safety. For every referral, an identical set of questions must be answered. This means the solution provides consistent advice designed by senior clinicians.

In the event of a medical mistake or dispute, Patient Pass provides a record of all interactions. This record is auditable and ensures KPIs are monitored and reportable.

Patient Pass has a reporting suite so the Trust can analyse metrics relating to all referrals. This provides operational knowledge to support vital planning around referral locations and types.

Feedback from all teams has been positive.

Referring sites are delighted they can make referrals in under 3 minutes and see the expected time to transfer to a renal bed.

Renal staff are highly satisfied with the reduced call volume. They like that they can choose when to respond to messages and that the decision support tools provide core clinical responses.

Functionality

The main functionalities Patient Pass offers include:

• secure two-way messaging
• single record of discussions
• trust-wide or single department rollout
• N3 / HSCN hosting
• live reporting dashboard and patient flow

Capabilities

Patient Pass enables referring hospitals to access fast responses and advice from the specialist team.

Scope

Patient Pass can be used to:

• refer patients to specialist services
• share clinical details and management plans

Patient Pass has since been successfully implemented in over 20 different specialties across 4 trusts. This includes the Renal departments at Leeds Teaching Hospitals Trust and Lancashire Teaching Hospitals Trust.

Key learning points

• Patient Pass is easy to set up.
• Start with a service where it's important to get a timely reply, but not an immediate reply.
• Use a service with a meaningful volume of discussion that could be done asynchronously.
• The Patient Pass user base has been developed through positive word of mouth.

For a successful rollout, the team:

• used a phased approach
• wrote to medical directors and chief clinical informatics officers of regional trusts for buy-in
• used the Patient Pass system with the old pager system for some time
• directed all non-urgent requests, that were sent through the old system, to the new system

The team also engaged the renal teams and users at referring sites throughout the development process. This ensured the system supported the workflow and provided appropriate information for safe clinical assessment.

Digital equalities

Any trust, even if it's not 1 of the 6 local acute sites, can access the system and contact the renal team. This means that the trust’s renal patients can access advice and care from their team wherever they are in the UK.

A phone service is still offered to ensure that advice can be provided for all patients who need support.

Key figures

• Over 700 referrals were made through the system in the first 6 months after it was launched.
• The system has now handled over 30,000 referrals for other services in the Trust. Around 7,000 of these are renal referrals.
• Over 85% of all new referrals are now generated using Patient Pass.
• In the past, people had to call the service and could be waiting up to 30 minutes. Now referrals can be made in under 3 minutes.
• Approximately 20 calls a day have been removed. This has improved access for urgent calls that require immediate discussion. The renal team can offer better care and support as a result.

Find out more

Watch the video about Patient Pass at Salford

Key contact

James Ritchie, Chief Clinical Information Officer, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust

james.ritchie@nca.nhs.uk

Alastair Campbell, Director, Patient Pass

acampbell@patientpass.co.uk