Delivering targets
Dr Kerry Tinkler The Royal Free Hospital in London needed to meet the government’s 18 week referral-to-treatment target.
From a number of high-volume challenged specialities carpal tunnel syndrome (CTS), with its mixture of diagnostics and therapeutics, was chosen as an ideal pilot for the Map of Medicine.
The role for Map of Medicine
Map of Medicine provided the foundation for the clinical service redesign. This was supplemented with existing evidence and clinical guidelines to ensure that proposed changes, eg. straight to diagnostic testing, were reviewed by key stakeholders.
Connecting for Health (CfH) protocols were followed to maintain clinical governance, and the Map helped identify which steps could be managed in primary care.
Milestones
- Identifying key stakeholders and core objectives for a review workshop. At this session the current service was mapped out and challenged. The objectives were subsequently reviewed and finalised
- Moving from discussion to implementation.
- Publishing and communication?
Challenges
- Getting stakeholders to the workshop and managing the subsequent editing and sign-offs
- Overcoming resistance to a decision-support tool
- Achieving buy-in and local ownership
Results
- Map of Medicine helped cut avoidable waits, transform clinical services and improve the CTS patient experience.
- CTS diagnostics and physiotherapy are now carried out in primary care. Unnecessary outpatient visits have been reduced, and more care is carried out in the community.
Patients are now only referred to secondary care when appropriate. Patient referrals are coordinated with the results needed for accurate diagnosis and treatment to start.
- Overall, processes that previously required 12 to 18 weeks are now handled by Royal Free in four to five weeks.
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