Mid Highland CHP

Efficiency Savings: New Outpatient Appointment DNA rates

1 / CURRENT POSITION
E4.3 NHS Boards to deliver agreed improved efficiencies for 1st outpatient attendance DNA, non-routine inpatient average length of stay, review to new outpatient attendance ratio and same-day surgery by March 2011 and pre-operative stay by March 2013.
Combined Mid-Highland CHP target for March 2010 - 5.6%
BY MONTH / ROLLING YR END
NOV 09 / 6.7%
DEC 09 / 6.8%
JAN 10 / 6.8%
FEB 10 / 7.2%
MARCH 10 / 7.7%
Overall NHSH target for March 2010- 6.9%
BY MONTH / ROLLING YR END
NOV 09 / 7.1%
DEC 09 / 7.2%
JAN 10 / 7.2%
FEB 10 / 7.1%
MARCH 10 / 7.0%
This report encompasses data from last year to the most up-to-date available in March 2010 and indicates that the March 2010 of 5.6% was unmet.The latest DNA rate for March appears to be showing an upward trend within Mid-Highland but Service Planning advice is to wait for the May result to see if this increase is sustained or if it is merely a fluctuation.
2 / ACTION PLANS TO ADDRESS
2yr baseline data of Mid-Highland based Consultants (ie Belford & Mackinnon Memorial hospitals) produced by Service Planning.
Advised by Ricky Dear (Costings Accountant) that a break-down of DNA costs to each site by Specialty is not currently available within NHSH.
Clinic Outcome Recording performance reports will have a drill-down facility to monitor levels of DNA patients per Consultant, per Clinic, per Site. It is anticipated that these reports will enable the Admin Team Lead to actively monitor those patients who DNA and to evaluate Clinician compliance with the Patient Access Policy.
Further roll-out of NHSH Patient Booking programme currently being implemented.
 Pre-assessment Service to be developed Highland wide.
Planned media work but this was put on hold due to Highland wide approach.
Lochaber, Skye & Lochalsh/RCWN
Focussed support for Medical Records, OPD and Secretarial teams at the Belford, Portree and MacKinnonHospitals from SIM in Feb 2010 to facilitate embedding the DNA Policy as part of the Patient Access Policy (MAPPP no.18).Support to RCWN provided by Jenny McKenzie and Fiona Matheson.
Desk top access to Departmental specific MAPPPssupported by SOPs (as applicable) have been made available to all Admin staff.
Staff identified in Skye at both sites for capturing data at source as part of the overall clinic performances and this data will be input by the ATL, extracted by the SIM and forwarded monthly through local reporting structures for evaluation.
The Patient Access Policy has also been discussed with the Mid-Highland base Consultants to reiterate current DNA policy and exclusions.
An adhoc report will be set up in the BelfordHospital which will identify DNA patients on a weekly basis with a view to isolating individual DNA episodes per Patient, per Consultant and per Speciality.
If after a period of review this pilot report is effective/user-friendly then learning will be shared throughout Mid-Highland CHP with a view to replicating this format.
2 / ACTION PLANS TO ADDRESS (CONTD)
DNADATAFORMID-HIGHLAND2009
Mid-Highland CHP based Practitioners.
COMBINED NEW/RETURN / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 1692 / 123 / 1815 / 6.8%
Return OPD Appt / 3250 / 301 / 3551 / 8.5%
Total / 4942 / 424 / 5366 / 7.9%
Raigmore based Practitioners at Mid-Highland sites
New Outpatient Appointment DNA rates
BELFORDHOSPITAL / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 1333 / 94 / 1427 / 6.6%
MACKINNONMEMORIALHOSPITAL / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 210 / 16 / 326 / 4.9%
PORTREEHOSPITAL / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 488 / 25 / 513 / 4.9%
ROSSMEMORIALHOSPITAL / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 1041 / 74 / 1115 / 6.6%
COUNTY COMMUNITY HOSPITAL INVERGORDON / ATTENDS / DNA / PLANNED ATTENDS / DNA RATE (%)
New OPD Appt / 288 / 27 / 313 / 8.6%
3 / . EXPECTED IMPACT OF ACTIONS ON PERFORMANCE
Overall reduction in DNA rates as a result of:-
  1. A move into the new NHSH Patient Booking service approach is expected to result in DNA rates <5%
  2. Improved patient choice
  3. Clear and supported clinical guidelines and policy
  4. Removal of frequent DNA patients as per DNA policy
  5. Improved communication between patients and service

4 / FORECAST OF RETURN TO PLANNED PERFORMANCE (ie Trajectory)
Improved efficiencies by March 2011 to reduce 1st outpatient attendance DNA rate
to 5.6% overall.