Published 8 August 2019
An audit of our pathology links in a typical week showed we usually had around 600 blood tests. We also looked at scan requests and found the week’s workload was 25 MRI, 40 X-ray and 25 ultrasound reports.
Around 20% of pathology and scans were found to be abnormal and requiring action. We estimated this meant around 120 patients a week would have to be contacted by telephone or letter. Of these, 80 would be called back to the GP.
The typical process would be for the doctor to identify potentially abnormal results and then for admin staff to ask the patient to attend. Those with urgent results would be contacted first.
Once a patient attended an appointment, one of four possibilities would arise:
• The results were normal and the patient could be reassured.
• The results were abnormal and the patient would require a repeat test, scan or additional tests.
• The results were abnormal and the patient would require a prescription.
• The results were abnormal and the patient would require referral or admission.
We felt there was a great opportunity to save appointments by creating a program that would allow the doctor to perform the above four actions using SMS texting, without having to see the patient face to face.
Our clinical team assessed the different outcomes for a wide variety of abnormal tests and scan results and created the following clinical templates:
• Twenty pathology results, including low ferritin, raised cholesterol, low vitamin D, abnormal K, abnormal Na, abnormal LFTs, stool Helicobacter pylori, urine – UTI, swab – thrush, HbA1c, TFTs and eGFR.
• Twenty scan results including PCOS, ovarian cyst, fatty liver, gallstones, fibroids, sciatica, inguinal hernia, bursitis, rotator cuff tear, varicoceles, hydroceles, ganglions, osteoarthritis, osteoporosis and meniscal tears.
We spent two months reviewing the above areas and designing templates that allowed the clinician to create an SMS message that would inform the patient of their condition and the next steps. The templates included fields that allow the clinician to communicate the actual results, explain what they mean, provide links to online patient information leaflets, tell the patient whether they need a script and advise on the need for further or repeat tests, onward referrals or review at the surgery.
We then commissioned a team of programmers to build the software. The software also allows us to automatically email password-protected blood test request forms and e-referral forms.
The practice has reduced the need for GP appointments by 40 a week, or 2,000 in a year. This adds up to 6.5 hours of clinical time a week – equivalent to at least £20,000 of locum expenditure per year. Opening up our access by working proactively means we have reduced our wait for a pre-booked routine appointment to less than one week.
We have also made savings on stationery, postage stamps and printer costs, as well as freeing admin and other staff from recalling and chasing patients.
Our staff are much happier with the new process, as the documentation is automatically sent to the patient and patients do not have to come back to the surgery for results. In addition, staff no longer receive requests for test results because of lost emails or letters.
We spent our own time and money to develop the solution as we felt it would bring significant savings. It was a new experience project-managing the development of a piece of software and ensuring we got the system we required and that it worked the way we wanted. The software itself is quite simple, and we have trained all our reception staff to use it.
We have been invited by the local CCG to present our findings to fellow GPs and by the local federation to consider testing in a cohort of five practices, with a view to rolling out the system to the remaining surgeries in NHS Haringey CCG.
Dr Muhammed Akunjee and Dr Nazmul Akunjee are GP partners in North London
This article was first published in Pulse magazine in March 2019; last reviewed: July 2019
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