Using digital questionnaires for transformative healthcare
Introduction
The Bariatrics Team at University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) identified that the method they had for collecting clinical information prior to appointments was operationally inefficient and had a negative impact on the patient experience. The team were keen to look at ways to improve this for their patients and the running of the service.
They began considering national guidance when assessing what was needed for improvement. National planning guidance described a number of nationally mandated developments to support roll out of new ways of working in outpatient services which could be improved locally. Part of this was to ensure patients were empowered to manage their own care and take an active role in agreeing their care plans in line with the personalised and population health agenda. This should include using new technology and alternative solutions to those traditionally implemented.
The overall aim of the work was to improve the efficiencies within the team to improve clinic appointment times, patient experience and provide more available time for professionals to manage their patients.
Problem
When patients arrived for their clinic appointment they were given a 10 page questionnaire to complete before their appointment. Asking patients to complete in this way affected the accuracy of the questionnaires, as the environment was not a confidential space and patients sometimes had to rush to complete the answers. This in turn affected the quality of the conversation the patient had with their clinician during their appointment. The clinician would only have a short amount of time to review and assess the responses before the appointment.
During the Covid pandemic, the team trialled sending the questionnaires to patients via email and post. The team experienced a number of problems with this, which included:
- Poor response/completion rate; patients either did not feel comfortable sharing their personal information in a less secure way or did not understand the value in doing so.
- Information Governance/Data Protection concerns; as the team did not have the funding or capacity to explore options and procure a system specifically for these questionnaires, they had to rely on usual email methods. This resulted in some personal information no longer being collected due to the insecure route.
- Administration resource; due to having to post or email out the documents this method required more administrative resource for possibly less quality information returned. The team also had to develop a method of securing the completed questionnaires safely once they were back in their possession as well as getting them scanned on to the patient admin system.
The main areas they wanted to focus improvements on were:
- Increasing the completion rate of questionnaires prior to appointments.
- Reducing the number of clinics overrunning, due to patients taking time to complete the lengthy questionnaire and the start of the appointment being delayed.
- Reducing the costs associated with producing and printing the questionnaire on paper.
- Improving the quality of the appointment in the allotted appointment time due to having all the information available.
- Improving patient experience.
Solution
UHDB had been using Patients Know Best for their patient portal since 2018 and so it made sense to use a system they already had for their patients and for the Bariatrics Team to make use of the questionnaire functionality available within it.
The Bariatrics Team, along with the Trust’s Improvement Team and support from Patients Know Best, worked together to understand the aim and agree the measures of success at the beginning of the project. It was agreed that the team would trial using the portal to send out the pre-appointment questionnaires electronically to improve the quality of the data they received back from patients and receive more completed questionnaires.
The key stakeholders worked together to develop and approve the use case, questionnaires and implementation plan. There was a go live, with a closely monitored pilot phase period for a few weeks. All key stakeholders monitored the use of the portal during this time.
Due to PKB already being embedded in the Trust it required minimal resource to implement and it provided the right functionality to meet the requirements of the team. PKB was already integrated with the hospitals Electronic Patient Record (EPR) system and the NHS App, this made it much easier for staff and patients to use than other options, and also prevented any concerns being raised around data sharing and information governance. It also required no extra funding for using PKB.
Overall, it only took 4 months from identification of the problem, to deciding to use PKB, designing the pathway, modifying local processes to go live.
Outcome
It was much easier to make use of an already established system within the Trust than seek a new one which was not integrated. The project successfully resolved the issues the team had known about, but prior to the pandemic had no reason or capacity to actually review it. They had a much higher completion rate than they expected and they are continuing to improve and develop over time. Having all the right data protection and information governance in place already ensured they had a safe and secure way of collecting and storing patient information. Providing a digital solution meant that they were saving costs, time and resources.
In the pilot period, the main benefits the Trust identified were:
- Time saved.
- At least 15 minutes saved per patient appointment.
- Out of 103 patients invited to clinic 84 attended face to face. Of these, 69 patients completed questionnaires.
- Improved process.
- Reduction in admin time in printing off the paper questionnaires.
- More efficiently run service on a day to day basis.
- Encouraging patients to take ownership of their own care.
- Paper/printer cost savings.
- An estimated £206 saved from paper/printing per annum, per clinic.
- Maximised the use and value of questionnaires in PKB.
- Improved patient experience.
- Improved patient experience - ease of filling in the form in their own time and environment.
- Improved staff experience (mainly due to the ease of reviewing patient information).
It was also noted that of 19 patients who Did Not Attend (DNA) their appointment, 13 (68%) did not complete the pre assessment questionnaire. As it appears there is a correlation between patient DNAs and incompletion of consultations this information could be further used to target those at risk of DNA/check if they are attending the appointment to reduce wasted appointments.
The most important benefit for the team, is the time saving it is giving their patients and the knock on effect this is having on their clinic time and efficiencies.
"As time goes on and we use the system more we are seeing new opportunities. For example, the advantages of the library to save on paper copies of information at various stages and so we don’t have to supply multiple copies when people lose them or forget we supplied them. Also being more informative to patients about what to expect from their appointments and the service pathway as a whole. More recently we are exploring the messaging service to consider virtual support whilst patients are on waiting lists. We have also spoken to another team in our department who are currently exploring the use of PKB. Our Audiology team have also gone ahead and set up their patient questionnaires in PKB too."
