what might help reduce waiting times in camhs? waiting... · what might help reduce waiting times...
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What might help reduce waiting times in CAMHS?
Bill Williams, General Manager and IAPT Project Lead, Tower Hamlets CAMHSDr Rebecca Adams, Consultant Child and Adolescent Psychiatrist, Tower Hamlets CAMHSDr Freya Gill, Clinical Psychologist, Newham CAMHS
The Need for Change• High referral numbers
• Long referrals meeting• Poor quality referral information
• Lack of systematic liaison with referrers/ families
• Delays in decision making • Insufficient information about alternative
services or self help
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LCL
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No. of referrals received by Newham CAMHS per monthCount
Increase in referrals Vs reduction in resource
Key Aims of Front Door Team
• Improve decisions: Do referred children require input from CAMHS? Can they be signposted to alternative services?
• Reduce waiting times for first appointment.
• Improve patient experience of referral process by offering a more responsive service.
A New Referral Process
Referral received
Referral meeting
(FD clinician and Senior)
Allocate (Routine)
Allocate (Urgent)
Redirect/Close
Feedback meeting
(FD clinician and Senior)
Triage
Group Exercise You are part of the CAMHS Front Door Team and as a group you are required to make decisions about incoming referrals.
Stage 1. Identify what should happen with each new referral:• Allocate (Urgent) • Allocate (Routine)• Triage• Redirect/Close
Stage 2. Identify what should happen with the triaged referrals: • Allocate (Urgent)• Allocate (Routine)• Redirect/Close
Newham CAMHS Front Door TeamDr Priti Patel, Consultant Psychiatrist, Project Sponsor
Dr Freya Gill, Clinical PsychologistSari Ross, Clinical Nurse Specialist
Dr Carly Huck, Clinical Psychologist Dr Brigitte Wilkinson, Consultant Clinical Psychologist, Lead Clinician
Frances St John, Family TherapistNazneen Ramsahye, Lead AdministratorAnnabelle Perdido, Team Administrator
Meredith Mora, QI Clinical Fellow
Key Aims of Front Door Team
• Improve decisions: Do referred children require input from CFCS? Can they be signposted to alternative services?
• Reduce waiting times for first appointment at CFCS from 11 weeks to 9 weeks by April 2015.
• Improve patient experience of referral process by offering a more responsive service.
Cycle 1: Develop a standardize triage assessment script
Cycle 3: Pilot the ‘Front door’ (triage) service
Cycle 2: Develop a self-help and local service database
Quality Improvement (QI) Programme
Cycle 4: Use interpreters in triage assessments
Cycle 6: Offer face-to-face ‘drop-in’ appointments
Cycle 7: Pilot combined DLC & ‘front door’ role
Cycle 9: Implement the ‘front door’ service
Cycle 8: Align referral admin with ‘front door’ service
PDSA cyclesPlan, Do, Study, Act
Driver Diagram
To reduce waiting times for CFCS from 11weeks to 9 weeks
by April 2015 and improve the patient
experience of referral to CFCS as demonstrated by
increased attendance at first
appointment
Referral Processes
Define Admin process for handling referrals
Define standards from CAMHS clinicians in liaison
activity with referrers
Streamlining referral processes
Identify and use onward pathways for cases diverted
from CFCS
Demand Management
Information provided to referrers about CFCS
Checklists/ Screening tools for referrers
Awareness events
Signposting to alternative services
Limited Capacity
Increase proportion of telephone consultation time
Workload balancing
Broaden interventions Develop self help materials
Standardise liaison activity with referrers
Develop telephone screening protocol for families
Develop welcome call to families accepted to CAMHS
prior to appt
Develop library of easily accessible self-help materials
Screening checklists for GPs/referrers
Review and rationalise info sent to families
Develop knowledge about alternative services in
community / ‘secret shopper’ users.
Review and develop administrative systems for referrals
AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS
Waiting Time Data• Average wait for first appointment has dropped from an average of 69 to
54 days for the whole clinic.
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40
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CFCS waiting time (days) referral to first appointment
Front Door Pilot
Warning: Data issues
Waiting Time Data
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LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-
13Fe
b-13
Mar
-13
Apr
-13
May
-13
Jun-
13Ju
l-13
Aug
-13
Sep
-13
Oct
-13
Nov
-13
Dec
-13
Jan-
14Fe
b-14
Mar
-14
Apr
-14
May
-14
Jun-
14Ju
l-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan-
15Fe
b-15
Mar
-15
Apr
-15
May
-15
Jun-
15Ju
l-15
% of families seen within 9 weeks
• % of families seen within 9 weeks has increased from an average of 47%to 66% for the whole clinic.
Front Door Pilot
Warning: Data issues
Triage Wait Times• The current average waiting time for a triage assessment is under 2 weeks.
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LCL
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5
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/14
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151/
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5
Average wait (days) from referral received to triage assessmentMeasure
Attendance Rates of First Face-To-Face Appointment
Data snap-shot: All referrals received in February 2015 (N= 60)
0%10%20%30%40%50%60%70%80%90%
100%
Attended DNA'd Declined
ExisitingProcess:
Triage:
Routine
Outcome after Triage Assessment
45%
22%
24%
4% 5%Allocate within CFCS
Close (no support needed/no contact made)
Re-direct to more appropriate service
Provide Self-help only
Re-direct to appropriate service and provideself-help
Service User Feedback
Limitations Advantages
Language barriers Familiar surroundings helps talk
Unexpected call Benefits of unknown voice
Challenges of unknown voice
Less exposing & more focused
‘[The triage call] was a lotmore better than going totalk to someone in person,because when you talk tosomeone in person it’s harderand especially if you’re in adifferent environment aswell… but when you’re athome & more relaxed... I justfind it easier..’
‘I just felt where I’vehad that womantalk to me in such anice way, I thoughtmaybe I’m going tohave that here [atCAMHs] as well…’
Being put at ease• Confidentiality• Expectations• Control• Clinician’s persona
Sense of relief and hope for help • Relief of beginning to talk with the hope of help• Off my chest• New conversations• Positive changes having talked
The experience of the telephone call
A Good Process• Call Length• Questions asked and use of measures• Better than a letter
Possible Areas for Consideration• Text notification of the call
• Clinician measures as conversational tools
From Triage to Assessment• Retelling the Story• Use of triage call in initial assessment
‘Maybe a text an hour before asking whether it’d O.K to call in an hour’.
‘When I’d already come out about the whole situation I thought oh I have to explain the whole situation again.. but I know I have to do it because it is going to help me.. So although it might be annoying saying the same thing over and over again… I found it fine’.
Feedback and ideas for improvementService User Feedback
What next?• Further evaluation - Service user feedback from families of
their experience• Service user participation – Ask young people to rate the self-
help materials we have sent and discuss how they would prefer to access it. Visit other local services to gather information about accessibility, projects etc.
• Eliminate weekly referral meeting – Front Door Team will enable service to respond to risky cases more effectively and for allocations to be made on a daily basis.
• Link up with related pilots within the service (e.g. primary care and schools link)
• Full Implementation – To provide Front Door Team to all referrals on a daily basis. Caution! Resource implications
Contact details
• Bill Williams: [email protected] 7426 2375/2400
• Dr Freya Gill: [email protected] 7055 8400
• Dr Rebecca Adams:[email protected] 7426 2375/2400