Case study: Clinical Pathway Group, The Royal Free London NHS Foundation Trust

Case study: Clinical Pathway Group, The Royal Free London NHS Foundation Trust

Introduction

Patient panels act as an extremely useful tool to discuss and improve parts of the patient journey. They provide an opportunity for discussion between healthcare professionals and patients, so that both can genuinely understand each other’s situation and move towards a mutually beneficial service improvement or solution.

It is important for an IBD service to continually improve to meet patient expectations but also to optimise efficiency both in terms of time and cost. Supporting patients in self-management and being flexible in the service provided to an individual supports both aims.

This case study fits under numerous standards, through the work with patients to improve specific parts of patient’s ongoing care pathway.

Statement 1.6

IBD teams should promote continuous quality improvement and participate in local and national audit.

Statement 1.7

Patients and parents/carers should have a voice and direct involvement in the development of the service.

Statement 7.2

Patients should be supported in self-management, as appropriate, through referral or signposting to education, groups and support.

Statement 7.7

All IBD patients should be reviewed at agreed intervals by an appropriate healthcare professional and relevant disease information recorded.

Who's doing it well?

The Royal Free London NHS Foundation Trust has been running a Clinical Pathway Group for 12 months. The Gastroenterology Department chose Inflammatory Bowel Disease as one of the pathways they wanted to develop. The Clinical Pathway Group includes the IBD team and the patient panel. The group have worked to jointly map the ongoing care pathway, aiming to reduce the overcrowding in medical outpatient clinics and numerous clinic cancellations, due to staff resources.

The idea

The group conducted a patient satisfaction survey. The survey included questions on current satisfaction with the clinics and asked how patients would feel about telephone and nurse-led clinics, as alternatives for follow up when they are well. It included offers to join a patient panel.

Following the survey, the patient panel was set up and worked with the IBD team to jointly map the current pathway for ongoing care. The group then worked together to develop a future pathway, detailing how the service should look.

The group decided that there should be an increase in nurse-led outpatient and telephone clinics and regular data review (for example, numbers of patients seen in consultant-led, nurse-led and telephone clinics). Crohn’s & Colitis UK information packs were provided to all, with reviewed service information and signposting to information on diet and fatigue. The service made sure they were advertising the London Patient Education Programme in outpatient clinics and online.

There was an agreement for routine monitoring and audit of clinical practice against the new clinical pathway. The Trust had discussions with the Clinical Commissioning Group about a community-based nursing post, following the group discussions. There were also discussions within the Trust regarding the use of an IBD app in the long-term.

The results

The new pathway led to a significant increase in the number of stable patients under review in nurse-led clinics (160 per month in April 2016 – 253 per month in Jan 2019). There was no reduction in the numbers of patients seen in the consultant face-to-face clinics, but this provided data evidence for a business case for more medical consultant resource.

I think teams working to improve their patient pathways should be really proud. It’s brave to open yourself up that way. Our panel views it as a partnership which gives us the opportunity to make suggestions about practical ways to improve patient care.

Jeffrey Goodwin, Patient Panel member