Department of Clinical Neurophysiology Glasgow

The Waiting Times Challenge

Anne Peden

Professional Services Manager

Background

• We provide a wide range of Neurophysiological investigations to a potential patient referral base of 2.7 million.

• Investigation performed include:

Standard EEG

Sleep Deprived EEG

Short Video EEG

EEG Monitoring including Intra-cranial recording

Evoked Potentials

EMG investigations, including Physiologist Led Nerve Conduction Studies

Staffing• 3 Consultant Clinical Neurophysiologists.

• 1 Locum Consultant.

• 2 Specialist Registrars.

• 10 WTE Clinical Physiologists (7 at SGH, 1 at WIG, 1 at GRI and 1 at SEC Bridge of Weir).

• 4 Trainee Clinical Physiologists.

• 1 Assistant Clinical Physiologist.

• 4 Administrative staff.

Waiting Times

At Jan 10 waiting times:

Investigation Min(weeks) Max(weeks) Min(months) Max(months)

EEG/Short Video

Clinical Urgency

4 0 1

Amb 8 10 2 2.5

VT 4 6 1 1.5

EMG/NCS Clinical urgency

112 0 28

Why?

0

1000

2000

3000

4000

5000

6000

7000

Total EMG referrals

Due to:• Significant expansion of Orthopaedic and Neurology services in West

of Scotland.

• In 1999/2000: There were only two Consultant Clinical Neurophysiologists employed within the department.

• Development also began of Specialised EEG Monitoring Services in Glasgow (including Intra-cranial recording).

• 2008/2009: Despite having 3 Consultant Clinical Neurophysiologists,

they were dealing with a growth of 300% in EMG referrals along with other clinical commitments.

What have we done?• Look at skill base of staff.

• Room utilisation: Where and when are labs free.

• Appointment slots: Increased EEG and Ambulatory appointments to ensure that these waits remain manageable.

• Re-organize EP clinics to set day/ times, to free-up space for additional NCS

• From June 09 introduced Physiologist Led Clinics for Carpal Tunnel Syndrome.

• Now have 4.5 Clinical Physiologists able to perform NCS (5 clinics per week).

• 1 Physiologists assisting clinic for NCS.

• Additional Locum Consultant appointed August 09

Outcome- Physiologist Clinics

0

2

4

6

8

10

12

14

16

18

20

Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10

Waiting Time(months)

What's next:• Waiting List Initiative Clinics for Consultant investigations, from March

to May 2010.

• Pooled EMG referrals, for Consultant led clinics (March 2010).

• Common vetting for all EMG referrals.(Urgent, Routine and Phys) Up to 45% of all referrals suitable for phys clinics.

• Increase number of Consultants from 3 to 5 by June 2010.

• Increase number of Physiologist Clinics from 6 to 10 by June 2010, thereby freeing up consultant time to deal with complicated investigations.

Conclusion Changes we have made have had a significant impact on waiting

times and therefore improved the quality of service we provide to our patients.

We realise there is still a lot of work to do, but we are heading in the right direction!