RNOH Patient group – Report

Subject: Fact finding visit to outpatients department

Date:July 15th 2009, 2.00 pm – 3.30 pm

Patient group members:Shirley Williams, Marion Cumbers & Maryam Habibzay

Staff interviewed: Unica Webb (Sister)

Area visited: Outpatient department and waiting areas

General environment: The area is clean and has undergone some refurbishment since our last visit. However the area gives an impression of general neglect. Major refurbishment is projected for January 2010.

Staffing: has improved since our last visit. Health care assistants now rotate through tasks at reception, and separate HCAs deal with pre-assessments in the Patient Centre. Interviews for another person are to be held shortly. As before, there was no volunteer at the helpdesk. Clear signage is in place to guide patients to X-ray, physiotherapy etc. Patients are escorted to physiotherapy by nursing staff when necessary to make appointments.

There are still only two receptionist work stations to handle the queues of patients checking in to the clinics and booking repeat appointments. We did not see queues when we visited, but they are reported to be worse on alternate Wednesdays. The clinics themselves were not running late according to the signs, because most patients were being delayed in X-Ray for 2.5 to 3 hours.

Waiting times for X-Ray have not improved, but throughput of patients is reported to be 2.5 to 3 times as many as at our last visit. Patients can still go directly to X-Ray ifthis is written on their notes. Delays are exacerbated by in-patients arriving from the wards. The MRI report backlog is improving. But there is still a 6-7 week wait.(for appt or the report)

Secondary referral waiting time has improved because of their position on the 18 week pathway having to be maintained.

Delays in getting through to the department on the phone to cancel or amend appointments were reported.

Transport:

The shuttle bus missed a very short lady waiting in the bus shelter, who didn’t recognize the bus as the shuttle, and was too short to read the timetable which was far above her head. Nobody spoken to had used the new transport assessment system, or hospital transport that day.

Patients/carers interviewed: 5

All the patients were very impressed and pleased with the care they were receiving at the RNOH, especially one with a poor experience at another hospital.

On closer questioning, each carer had had trouble finding a parking space, but had succeeded in the end. Those needing to attend X-Ray had had waits of 2.5 to 3 hours.This often means that Staff are waiting around for patients.These problems were accepted as normal by previous patients. Those attending for the first time had been given sufficient information to facilitate their visit. None had used or tried to obtain hospital transport.

One Patient had been coming to the hospital since December 2007,including a long stay as an In patient.She could not speak highly enough of her care,except for the waits in X-ray.As they live in Surrey this meant they were always ‘catching ‘the M25 ‘rush hour’.They deliberately arrive early if they need an X-Ray.

  • The shuttle bus shelter need to be kept clear of obstruction by ambulances, or relocated to give clear line of sight.
  • The timetable needs to be lowered to allow all to read it.
  • The upper parking area nearest the clinic needs to be reserved for blue badge holders, drop off zone and ambulance to prevent congestion.
  • Wheelchairs are supplied by the porters, and there is often a delay in their arrival. Are they disinfected regularly? -who cleans them?
  • A small amount of remodeling of partitions would allow three receptionist computer station and splitting of queues into appointment bookings and outpatient check-in which might alleviate queuing problems. This could be tried out before any remodeling is done, to evaluate if there is any improvement.
  • Why is an X-ray appointment notified manually to reception staff by a yellow slip attached to the notes rather than by looking at the patient records on the computer system?
  • Could patients needing to make physiotherapy appointments use a computer terminal or telephone from out patients rather than physically going to the department? This would save staff time and their energy.
  • Dedicated X-Ray provision for outpatients would remove the queues and improve throughput.
  • Could an email or phone system be put in place that takes a message or arranges for a call to be returned if you leave your name and number? Patients cannot be blamed for not cancelling an appointment if they are unable to get through.

Our thanks to Sister Webb for an interesting and informative visit.

Response form the OPD staff

The report and comments that the Patient group made is a true reflection of what they observed on the day of their visit.

As we are not informed when the volunteer are not here, I am unable to say why the desk was left unmanned.

There are plans to refurbish the out patient department. I am unable to give a start date at present and I am sure their recommendation will be considered.

Cards are used to identify patients who need to be sent to x-ray on arrival as it saved time having to go into another window and it’s visible to both patients and staff.

It is currently being looking into to find who is responsible for cleaning the wheelchairs.

The idea of email and answer phone for patients to book physio appointments is to be discussed with the Outpatient Manager.

1