City & Hackney CHAMHRAS reduce waiting times!

City and Hackney Adult Mental Health Referral and Assessment Service (CHAMHRAS) are the single point of entry for all mental health referrals. Their QI project has been running for 2 years. The team initially prioritised reducing waiting times, as only 30% of patients were being seen within 28 days. The project aim was for 95% of patients referred to City and Hackney Secondary Care Mental Health Services to receive a face to face assessment within 28 days of their referral being received by 1^st April 2017.

The change ideas that they tested were both practical and cultural. The main practical change was to create a spreadsheet tracker, which enables the team to log all referrals coming in and follow them through. Through this they were able to see when appointments were made outside the 28 day threshold and when appointments were not made at all.

The team also focused on changing the culture, so that staff members were aware of the benefit and importance of people being seen within 28 days. This was largely about discussion with stakeholders involved in the process, such as administrators and clinicians, and working through together how to effectively manage appointment bookings. The team have seen a huge improvement, with 93% of GP referrals now being seen within 28 days! These fantastic results were in spite of experiencing a 214% increase in referrals over this period.

The team are now focusing on implementation steps for their waiting times work. Currently the administrators spend a lot of time marrying up what is on their local spreadsheet with what is on RiO (our electronic care records system), so they are keen to work alongside the RiO team to explore how they might be able to develop RiO to do this within the system to avoid the double-running of systems and the risks/inefficiency this involves.

The team noticed that following a decrease in their first appointment wait times, their DNA rates had increased. The team’s theory was that the increase in non-attendance was related to an increase in inappropriate referrals or service users possibly going into crisis whilst waiting for an appointment. The team used to spend time gathering information about a referral, ensuring the referral was appropriate and providing the service user with information about the service that they had been referred into, rather than booking them into an appointment straight away. The team are now focusing on reducing DNAs to further improve patient experience and the efficiency of their system with the aim to reduce first appointment DNAs to 20% by September 2017. The PDSAs (Plan Do Study Act) they are working on are:

1. Testing the use of text messages with information about costs to the NHS (based on the Cabinet Office work with Bart’s health which established this was most likely to change behaviour). This is including work by a trainee psychologist to explore how service users feel about including cost information and other content in text messages, as well as their experiences and views on factors contributing to DNAs.
2. Improving information for service users and carers
3. Improving information for referrers