G18(P) Improving delayed follow up appointments in community paediatric service using QI (quality improvement) methodology

Background There were concerns regarding the large number of children waiting for follow up appointments well beyond their due date in the Community Paediatric service causing a clinical risk. This included children with children with complex neurodisabilty and children who were on medication for ADHD. Methods A quality improvement project was undertaken with the aim of reducing the number of delayed follow up appointments by 25%, by 1 st June 2018. The rationale for the project was to identify the reasons for the delayed follow ups and to explore ‘change ideas’ as interventions to improve on the delayed follow ups thereby improving patient care and parent satisfaction. The process measure was the number of months by which the children were overdue. Six change ideas were tested. They were redistribution of Associate Specialist clinic slots, extra clinics, protected follow up appointment slots, case note review of children waiting for more than a year and sending out letters to parents about possible discharge, telephone consultations and offering appointments as they leave the clinic. The weekly data of the number of children with delayed follow up appointments was collected as the outcome measure. A process mapping was done to identify the steps of the child’s journey from the initial appointment to follow up appointment. A questionnaire was given out to parents when they came for review appointments asking whether their child’s care was affected due to the delayed follow ups. Results When the quality improvement project was started in January 2018, there were over 200 children with delayed follow ups. Initial data in March 2018 showed that this number was 212.By 1 st July 2018 this was down to 66. The most effective change idea was offering clinics with protected follow up slots. There have been substantial improvement seen which is ongoing. Conclusions Our dedicated and skilled team has always discussed ideas about reducing delayed follow ups. Using quality improvement methodology we were able to harness these ideas to make change and maintain improvement. The next steps will be to spread the change and extend the culture of quality improvement within the team.