Figure 2: Patient referrals - reason for referral
3. Clinic trial run, then full launch a fortnight later Since introducing the virtual dietetic service at The Royal Brompton back in March this year, ongoing reflection on ways in which to improve the service has been important. The following changes have already been implemented to overcome barriers identified: • We have sought a dial code to enable calling mobile phones without going through switchboard which was causing delays. • We have started to keep a record of phone numbers with the clinic bookings to optimise efficiency. • Initially appointment booking letters needed to be written manually, whereas now the computer system can produce these automatically following appointment booking. • We have adjusted the laptop settings to stop it logging out or locking the screen during the consultation. This enables documentation directly on to electronic records rather than using paper. • Our referral process is being reviewed to use an electronic program as used for bloods requests, rather than the current electronic form which is then emailed. • Skype has proved difficult due to information governance; the trust has Skype for business; however, this is challenging to use, even for interviews. • We now seek patient consent to email letters, as currently posting takes additional time and resources.
4. Promotion The ongoing feasibility of the clinic is dependent on referrals and, therefore, the following promotions have taken place to raise awareness of telehealth dietetic clinics: • Announcement to multidisciplinary team via email and during meetings. • Involvement of key stakeholders throughout the process including physiotherapists, consultants, dietitians. • Electronic referral and criteria link on intranet via simple search. • Ongoing informal verbal reminders and via patient letters. • Informed CQUIN team to support the NHS England funding bid. • Linked with hospital marketing and communications resulting in promotion article publication in monthly bulletin which is emailed to all and printed versions distributed around the hospital. 5. Outcomes data analysis It is still very early days following the initiation of the clinics and, therefore, this has not been formally assessed or monitored, but this is crucial going forward to ensure sustainability and feasibility. General observations so far: • There have not been any DNAs. • Works for dietitian, MDT and patients, with positive feedback to support this. • Outcomes data being collected includes source of referral, reason for referral, weight changes, BMI changes and transplant www.NHDmag.com July 2017 - Issue 126
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