Waitemata DHB completes approximately 20,000 outpatient appointments each month and demand continues to grow. We need to understand the reasons for and outcomes of our outpatient appointments to better manage our resources and service quality. Clinician-confirmed diagnoses are critical to our understanding.
Traditionally our outpatient clinicians have used a paper outcome form - without a diagnosis - to record administrative outcomes of appointments eg whether a follow up appointment is required.
What are we trying to achieve?
We want to develop a system to better understand the purpose and outcomes of outpatient appointments to help us manage demand and improve practice.
We aim to develop, implement and evaluate an electronic version of the paper outcome form including diagnoses, with a single outpatient specialty over a three month period.
What did we find?
Our rheumatology outpatient service recognised the value of adding a clinician's diagnosis to their paper outcome forms. They trialled a paper outcome form with the diagnosis included, but this was difficult to expand to other services as it was complex for administrators to manage. In addition, the paper-based process was associated with risks that included lost forms, poor form legibility and errors associated with duplicate data entry.
Systematic electronic recording of outpatient diagnoses will help us to:
Improve Patient Outcomes
- Monitor outcomes that matter to patients and clinicians for specific diagnoses
- Monitor how we are doing against best clinical practice guidelines for specific diagnoses eg seeing people with specific diagnoses within clinically acceptable timeframes, making sure we see them enough times
- Identify areas where we are doing really well / doing not so well
- Monitor whether or not strategies / interventions to improve processes or outcomes are working
Improve Patient Experience
- Provide better information to patients with a specific diagnosis about:
- what services they can expect from us, eg how many follow-ups and over what period of time would be usual for this diagnosis
- what outcomes they can expect from our service
- Patients with specific diagnosis could provide us with information about what is of most importance to them, so that we can make sure that our service aligns with their needs
- Minimise appointments unlikely to deliver much clinical benefit for patients with specific diagnoses