Doncaster hitting 24 hour turnaround time for clinical correspondence

24 hour challenge

Doncaster and Bassetlaw Hospitals NHS Foundation Trust, in agreement with their Primary Care partners in South Yorkshire, pushed the bar even higher, aiming to deliver all outpatient clinical letters to GPs within 24hrs, alongside the national target for discharge summaries.

Julie Ekins, Service Improvement Manager at the Trust, explains: “Part of the evaluation process was not simply to consider how to hit the discharge summary 24hr target, but also how to work more closely with the PCT to provide a better service in terms of more timely and accurate information to GPs.

Two and two equals five

The Trust originally looked at both digital dictation software and document workflow solutions as options to improve communications with GPs. While the individual benefits of such solutions were already clear, the project team identified that the greatest opportunity came when integrating the two systems to provide a true ‘start to finish’ electronic process. 

“Digital dictation is an obvious improvement on analogue,” explains Jay Dugar, Consultant ENT surgeon at the Trust, “as it eliminates the time-consuming process where file notes and audio cassettes are physically moved between hospital departments, with all the opportunities for delay and errors that this entails. But it still doesn’t take the paper out of the letter approvals process.

“If the secretary follows the standard process – where she types up a letter from the digital dictation, prints it out, gives it to the clinician and on approval, posts it out to the GP – it takes several days not hours. To speed up delivery, we needed to fill the gap between capturing information digitally and how it was handled and communicated thereafter.”

The electronic correspondence solution piloted by the Trust in 2010 automatically matches a digital dictation with the corresponding central Patient Administration System (PAS) details to produce an electronic clinic attendance letter or discharge summary which can then be checked and delivered electronically.

Mark Norwood, Head of IT at the Trust comments: “The combined Medisec and TalkingPoint system brought together two tried and tested systems in one integrated electronic offer, developed in consultation with clinicians, our service improvement manager, IT staff and GPs.  We’ve never seen such a seamless solution before.  It allows us to track progress from the point the dictation is captured, all the way to when it is delivered to the GP.” 

The average time from a patient attending a clinic (or leaving the hospital after treatment) to the relevant clinical correspondence being made available to GPs for instant download, has now been halved from 8 days to 4 days. More than 100 clinicians are using the system and in February created 11,000 pieces of digitally dictated clinical correspondence.  Of these, nearly a third (27.5%) are being delivered within the 24 hour target the Trust set itself.

Julie Ekins comments: “The new system has proved that 24 hour delivery of clinical correspondence really can be done and we’re delighted with the results. The 50% cut in time taken is, in reality, probably much higher than this as we cannot compare current results against a baseline (because we never measured performance before!).  Eight days is how long it took with just the Medisec document generation system in place; four days is how long it takes now that we have integrated digital dictation into the system.

“Although human intervention will always stop us from delivering within 24 hours 100% of the time, we’re certainly hoping to improve on this over the coming months.”

How the system works

The consultant creates a fully customisable workflow of outstanding dictation using MedisecTRUST.  When a patient is selected, the system opens the integrated TalkingPoint software. The resulting voicefile is tagged to the patient and the activity and once it has been approved by the author, it automatically appears in the relevant medical secretary’s workflow (without them having to search for it).  It also allows pooling or cover by another secretary in the same department. 

When the transcriber opens the voice file, the system automatically inserts patient information from the hospital PAS (e.g. date of birth, address, NHS number and GP) into a letter template, also generated by the system. Once the transcription is completed, the document is then forwarded to the consultant for review and electronic sign off, before being made available electronically to the relevant GP.

Adds Mark: “With Medisec, everything is digitally tagged and therefore much faster to find and action.  As letters are signed off electronically, there is no waiting for secretaries to wade through transcripts or for tapes to find their way around hospital departments.”

The technology allows the Trust to hit the 24 hour target even when consultants are working across several sites.  Jay Dugar explains: “Before, if I attended a weekly outreach clinic in Bassetlaw on a Monday, for example, I often wasn’t able to sign off the ensuing letter until the following Monday when I was back in the clinic.

“Now I can dictate a letter on one site in the morning and approve it in the afternoon from another site. Medisec gives me an instant, on-screen alert telling me how many letters I have pending to approve and I can check and sign them off electronically from any of the three sites where I work. I can usually sign off my morning clinic letters on the same day and my afternoon clinic letters the following morning.”

The technology used to issue the letters electronically to surgeries links almost seamlessly with the GP system, as Jay explains: “As soon as I authorise a letter, before a patient has even left the clinic, the surgeries are able to simply download it into their inbox.”

The electronic inbox is in trial phase now in a number of surgeries and Medisec has recently added the option for an automated feed into GP software system TPP System One.

Trust-wide roll out

Following an initial pilot with clinicians in Ear, Nose and Throat, the integrated approach is now being rolled out across the whole of the Trust and to GP surgeries within the Doncaster and Bassetlaw areas. 

“The response so far has been very strong,” claims Julie. “The consultants are working well with the system and we’ve also had positive feedback from the secretaries.”

Electronic storage means that secretaries can quickly and easily locate the information they need to respond to enquiries and other users can directly access letters from PAS for viewing.

The software offers benefits across the board, as Julie describes: “It will enable the Trust to report accurate data to the PCT. Previously we could only manually monitor how long it takes to create letters. Once they’re in the post, we had no control over them. The new system puts us much more in control as we can prove how long it has taken from a patient leaving a clinic to the GP being able to access the relevant update.”

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