How NUH reduced unnecessary follow-up appointments by 30%

DrDoctor was already embedded at NUH, having reduced the Trust-wide DNA rate by 30% and saving £1,722,000 a year between 2015 and 2017 through Appointment Management.

Follow-up Management was the next step in NUH's digital transformation - moving from reducing no-shows to reducing unnecessary attendances altogether.

Figure 1. NUH's DNA rate for Diagnostic Imaging before DrDoctor. Figure 1 shows the Trust wide DNA rate for NUH compared to the send rate of messages to patients from DrDoctor. Send rate and DNA rate appear to be inversely proportional, with the DNA rate decreasing as the send rate increases. This can be seen as the send rate increased and DNA rate dropped further when the consent model change took place in March 2017.

DrDoctor worked with NUH to implement our Assessments module, giving patients the choice to fill out questionnaires digitally. These forms can then be reviewed by the clinician who will advise whether a face-to-face follow-up is necessary.

The solution has been built to help reduce unnecessary follow-up appointments without increasing clinical risk or reducing patient experience. Our aim is that clinics will run with fewer delays and will facilitate better use of clinician time without compromising on patient safety. 

The project started with a pilot implementation in Oncology, with the intention to roll out the solution in Breast and Trauma & Orthopaedics. Once the desired pilot results are achieved, it is planned that digital assessments will be rolled out Trust wide and to hospitals across the East Midlands.

Figure 2. Screenshots of the solution for reducing follow-up activity. Examples of the patient portal (left), where patients can fill out pre-clinic surveys remotely, removing the need for them to be in-clinic for this part of their care journey. And the staff portal (right) where hospital staff can access patient assessment results and make more informed decisions about a patient’s care remotely and in a timely manner.

Now that the pilot is live in Oncology, we are excited to work with the Trust to realise the desired benefits that NUH have set out - to lower unnecessary follow-up appointments by 30%. Specifically, DrDoctor and NUH have highlighted the following as being key to the success of this project:

• Significantly fewer patients attending outpatient appointments in person

• Maintained (or improved) patient satisfaction feedback 

• Fewer outpatient delays and clinics running late 

• No compromise on patient safety 

• Freeing clinician time for other areas of patient care

• Long term cost savings - avoids need for expensive expansion of outpatients in the future to cope with increasing demand 

This project will enable NUH and DrDoctor to provide answers to a suite of questions, furthering the work already completed in order to transform the outpatients department at NUH. These include: 

• Which patients don’t want or need to be seen?
• Which patients have unexpected symptoms and need urgent clinic review?
• What specifically do patients want from a face-to-face consultation and how better can we give that to them if there is not clinical need to be seen?