Respiratory Physiology Diagnostics

North East GlasgowRoger Carter

Consultant Clinical Scientist

The service we provide The North East Glasgow Hospitals provide lung function service to a local population of 350000A wide range of diagnostic respiratory physiology services are delivered from two dedicated respiratoryphysiology laboratories based at Glasgow Royal Infirmary and Stobhill Hospital In total 42 respiratory sleep

investigations have been coded

The following investigations are offered at both sites bull Spirometry bull Bronchodilator Assessmentbull Lung Volumes by Body Plethysmography bull Transfer Factor and componentsbull Ear lobe capillary blood gases bull LTOT Assessmentbull Ambulatory Oxygen Assessmentbull Flight Assessmentbull Bronchial Reactivitybull Cardio-Pulmonary Exercise Testingbull Surgical Risk Assessmentbull Nebuliser Assessment bull Nebuliser Exchange Servicebull Outreach Spirometry (GP Flow Volume Loops) bull Respiratory Muscle Assessmentbull Respiratory Drive bull Sniff Pressures

Volume Time Curves

Time (Seconds)

Vol

ume

(Lit

res)FEV1

Normal

Obstructive

Severe Obstruction

Restrictive

Flow Volume Loops - Emphysema

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indooroutdoor pollutionindooroutdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

The service we provide The North East Glasgow Hospitals provide lung function service to a local population of 350000A wide range of diagnostic respiratory physiology services are delivered from two dedicated respiratoryphysiology laboratories based at Glasgow Royal Infirmary and Stobhill Hospital In total 42 respiratory sleep

investigations have been coded

The following investigations are offered at both sites bull Spirometry bull Bronchodilator Assessmentbull Lung Volumes by Body Plethysmography bull Transfer Factor and componentsbull Ear lobe capillary blood gases bull LTOT Assessmentbull Ambulatory Oxygen Assessmentbull Flight Assessmentbull Bronchial Reactivitybull Cardio-Pulmonary Exercise Testingbull Surgical Risk Assessmentbull Nebuliser Assessment bull Nebuliser Exchange Servicebull Outreach Spirometry (GP Flow Volume Loops) bull Respiratory Muscle Assessmentbull Respiratory Drive bull Sniff Pressures

Volume Time Curves

Time (Seconds)

Vol

ume

(Lit

res)FEV1

Normal

Obstructive

Severe Obstruction

Restrictive

Flow Volume Loops - Emphysema

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indooroutdoor pollutionindooroutdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Volume Time Curves

Time (Seconds)

Vol

ume

(Lit

res)FEV1

Normal

Obstructive

Severe Obstruction

Restrictive

Flow Volume Loops - Emphysema

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indooroutdoor pollutionindooroutdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Flow Volume Loops - Emphysema

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indooroutdoor pollutionindooroutdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

SYMPTOMScoughcough

sputumsputum

dyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobacco

occupationoccupation

indooroutdoor pollutionindooroutdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

NICE COPD 2004 Severity of obstructionFEV1FVC lt70

bull FEV1 lt80 gt=50 Predicted

bull Mild airflow obstruction

bull FEV1 lt49 gt=30 Predicted

bull Moderate airflow obstruction

bull FEV1 lt30 Predicted

bull Severe airflow obstruction

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Diagnosis Asthma

bull The diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the absence of an alternative explanation for them

bull If high probability - trial of treatment

bull LowModerate - attempt to find airflow obstruction (Spirometry with reversibility to acute bronchodilator administration)

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Intermediate Probability of Asthma

bull In view of lifelong treatment seek objective evidence of airflow obstruction

bull Spirometry is preferred over peak flow at diagnosis

bull Caveat - normal spirometry if asymptomatic does not exclude asthma

bull Peak flow diaries demonstrating airflow variability are helpful

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Management of stable COPD

100

80

60

40

20

Healthy population

Smokers coughLittle or no dyspnoeaNo abnormal signs

Exertional dyspnoeaCough amp sputumSome abnormal signs

Dyspnoea on mild exertionHyperinflation amp cyanosisWheeze amp cough

Death

Wo

rsen

ing

lu

ng

fu

nct

ion

FE

V1 a

s

pre

dic

ted

Increasing investigation and treatment

Smoking cessation

Antibiotics for acute infections

Trial Symptomatic bronchodilator therapy

Trial Long acting BronchodilatorsInhaled steroid if freq exacerbations

Influenza vaccinationPulmonary rehabilitation

Assessment for LTOT

Symptoms

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Waiting Times Spirometry

bull 2007ndash Average Waiting Time 9 weeks

ndash Longest Waiting Time 12 weeks

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Make a difference by

bull Introduction of efficient administrative systems to manage the booking system more effectively and improve local pathways

bull Reduction of waiting times by actively managing the booking of diagnostic respiratory tests and the use of first available spirometry slot at any north east site

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Making a difference what we did bull Previously appointments for the service were booked onto a paper diary list by an assistant

technical officer bull We have developed electronic clinic templates for Respiratory Diagnostic testing on the PAS

system bull These are at present appointed by clinical physiologists bull This has enabled

ndash 1048707 Flexible booking system - better time management relative to the type of tests and specialty clinics

ndash 1048707 Record accurate data on patient administration system

bull Owing to the complexity and time consuming nature of some of the investigations short notice patient cancellation or non-attendance are particularly wasteful of resources and this can occur on a regular basis Patients who cancelled appointments were regularly offered repeat appointments increasing the length of the waiting list and reducing the availability of slots

bull The administrative team actively applied the health boardrsquos waiting list policy so that patients who do not attend or cancel their appointment twice are removed from the waiting list and returned to their referrer with an explanation of the action Also patients who decline two or more reasonable notice appointments but still wish to be investigated are clearly flagged under patient choice and do not reflect in the waiting list statistics

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

What benefits did we achieve

bull Streamlined patient booking pathway therefore better patient experiencebull The ability to offer first available appointment at either laboratory (two

laboratories but single service) if the patient was prepared to travel or the most appropriate site at the patientrsquos request

bull Reduced number of patients arriving without referral forms and patients are better informed (Clinical Portal Access)

bull Flexible booking times ndash increased capacity for one-stop clinics bull A reduction in cancellations and DNAs bull A reduction in waiting times bull Involvement in the Diagnostic Working Group to review the waiting list

policy and the inclusion of diagnostic services in to the waiting list policy (DMMI)

bull Improved staff awareness of current waiting lists and activity through the publication by the department manager of monthly statistics

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

How we measured the achievement

bull Data analysis from PAS bull Reduced waiting times for new patients from 9

weeks to approximately 4 weeks bull Increased one-stop clinics due to better time

management by physiologists bull Reduced waiting times were observed in the

monthly returns bull Tables indicating the waiting time trends and

including activity referral and patient DNAs

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY

Wait

Days

Weeks

0-7

1

8-14

2

15-21

3

22-28

4

29-35

5

36-42

6

43-49

7

50-56

8

57-63

9

64-70

10

71-77

11

78-84

12

85-91

13

gt92

gt13

NOV

2008

22 25 17 17 78 231 126 63 23 10 9 5

NOV

2009

118

92 155 256 8 2

FEB

2010

59 53 153 267 102 1

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

What challenges did we face in making this idea work for us bull The transfer of appointments from the paper diary to the PAS

system involved a concerted effort of clinical physiologist time bull Natural scepticism of clinical physiologist staff in initiating this

booking system and the move away from a paper diarybull Training the clinical physiologist staff to manage our investigation

bookings in line with additional information being provided by the waiting list tables whilst still maintaining a sensible rationale for patients with different indicated clinical urgency

bull Ensuring all multiple cancellation and DNA patients were managed in accordance with the Trust waiting list policy and where there was any ambiguity to discuss each case with the Consultant Clinical Scientist

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development

Further Developmentbull A dedicated administrator appointment to manage

patient bookings ndash Freeing of clinical physiologist time presently spent on doing

routine administrative tasks to perform respiratory diagnostics with a proposed further fall in waiting times

bull Introduction of electronic booking of respiratory diagnostic tests through the clinical portal with associated reduction in paper referrals and reduction in time spent in obtaining referrals through the internal mail

bull Scoping of all respiratory physiologysleep diagnostic tests (42 in total) to address 18 weeks RTT

• Respiratory Physiology Diagnostics North East Glasgow
• The service we provide
• Volume Time Curves
• Flow Volume Loops - Emphysema
• Slide 5
• NICE COPD 2004 Severity of obstruction FEV1FVC lt70
• Diagnosis Asthma
• Intermediate Probability of Asthma
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Waiting Times Spirometry
• Make a difference by
• Making a difference what we did
• What benefits did we achieve
• How we measured the achievement
• Example Table Number of patients waiting listed by period since the date orv receipt of referral for the test as at last day of the month SPIROMETRY
• What challenges did we face in making this idea work for us
• Further Development