Assessing the Effects of Implemented Service Improvements on Patient Flow:A Prospective Study in a Specialized Vascular Access Unit

Maria Giannakopoulou Lead CNS, John Alston Data for Improvement Analyst, Joanne Crofts CNS, Joanne McGee CNS, Helen Summers CNS, Erickson Dela Mines SSN, Miguel Fernandez SSN, Cristine Co SSN Cambridge University Hospitals

Introduction

The Vascular Access Unit at Cambridge University Hospitals NHS Foundation Trust, established in 2005, specializes in addressing the complex vascular access needs of patients with services ranging from ultrasound guided cannulation, line reviews, midline and central line insertions and removals. Post pandemic, the unit has experienced a notable increase in referrals, a rise from 6900 to 9600 per year between 2018-2019 and 2022-2023, as well as an uptick of deferred cases in early 2022. In response, VAU implemented a comprehensive strategy to address this and established KPI’s to monitor the effects of said service improvements from the end of 2022 to present. 

Objectives

This study aims to assess the impact of implemented service improvements that were focused on workforce and the current electronic system that was in place.  The study also seeks to identify sustainable changes and highlight areas requiring modification and improvement to enhance the unit’s ability to adapt to the dynamic demands for vascular access in Cambridge University Hospitals, contributing to improved and timely patient care delivery.

Methods

Data from the unit’s activity logs from 2019 to 2024 were collected and analysed. The   difference between the time of completion and the point of referral was calculated to determine the number of 'roll-over days' for each case. Subsequently, these 'roll-over days' were tallied and divided by the total number of cases concluded within a given month, yielding the average 'roll-over days' per month. A target time of 0.8 'roll-over days' was established and the impact of the implemented service improvements on patient flow was evaluated against this. 

Results

Prior to implementing service improvement changes, the average time for the unit to complete referrals was about 1.7 days. Since the implementation of these changes, there has been a gradual reduction in the average referral completion time to just 1 day. Notably, in December 2023, the quickest response time achieved was 0.6 days. However, it is worth mentioning that during the initial phase of change implementation, referral completion times were notably prolonged.

The service improvement initiatives have operated synergistically to significantly reduce the 'roll-over days' per case.

The implementation of a comprehensive referral system has notably enhanced patient flow by reducing triaging time, although there remains room for improvement as certain crucial questions are still overlooked.