Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013 http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx A root cause analysis of cancellations data Andy McAllister Directorate Performance Manager, Wrightington, Wigan and Leigh NHSFT

1. An analysis of
cancellations
data
Andy McAllister –
Directorate Performance
Manager, Wrightington,
Wigan and Leigh NHSFT
ST05_Mar12
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2. WWL
• 3 sites + outpatients centre
• 300k population
• 758 inpatient beds
• £220m invested each year
• 300,000 outpatient appointments pa
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3. Endoscopy at WWL
• 2 sites
• 45 sessions per week in 5 endoscopy rooms
• 32 sessions for gastro, flexi sig and
colonoscopy
• Approx. 15000 patients in 11/12
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4. 9 months ago
• 13% increase in demand over 3 years
• WLI restrictions / loss of backfill
• High numbers of 6 week breaches
• Long waiting time for routine procedure
• A large backlog of surveillance patients
– Private sector support
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5. Performance
• In-house capacity – 180 units short per month
– Recovery space / room 3 Wigan / single sex lists
– Private sector support
– Hanover
• No electronic booking system
• Staffing vacancies
• DNA rates 7%
• 83% slot utilisation
• 80% sessional utilisation and backfill
• Significant reduction in breach patients
• Surveillance backlog
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6. Cancellations data
July 12 August 12 Sept 12 Oct 12 Nov 12
Cancellations 324 437 437 301 307
%age of total 27% 30% 34% 23% 25%
actvity
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7. High cancellations mean...
• Short-notice cancellations mean struggle to fill
the slots
• Low slot utilisation = decreased capacity
• Increased costs to find more capacity
• Increased waiting times
• More work for admin staff
• Poor patient experience
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8. What did we do
• Worked with Business Intelligence to
analyse the data
• Highlighted the top 8 reason codes
• Explored the issues for the top 8
• Initiated key actions where possible
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9. Top 8 reason codes
• 223 cancelled before day other reasons
– Sharp reduction in Oct and Nov – drive to
reduce ‘other reasons’ coding
– Sharp increase in ‘personal reasons’
cancellations instead....
• 98 ‘Doctors unavailable’
– July / August = 82
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10. Top 8 reason codes
• 85 ‘operation brought forward’
– Brought forward to fill cancellation slots
– A direct result of high cancellation rates
• 94 ‘operation not needed’
– Majority cancelled by patients
• 128 ‘patient does not want operation’
– Majority cancelled by patients
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11. Top 8 reason codes
• 132 ‘patient is ill’
– Majority cancelled by patients
• 187 ‘patient on holiday’
– 2-3 weeks notice given to patient
• 243 ‘personal reasons’
• 2-3 weeks notice given to patient
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12. Actions
• Introduced text reminder service
• Increase booking to 6 weeks in advance,
giving patient more notice
• Reinstated booking by telephone
conversation rather than letters
• Offering choice of date – no capacity in
Healthcare Operations team to do this
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13. Summary
• Useful exercise to understand the size of the
problem and to start to analyse the reason
codes
• Admin time enormous to process / rebook slots
• More work to do looking at how staff are coding
cancellations
• Offering choice of date – some way off
– Electronic booking system – should free up
admin staff time to offer this choice
• Perhaps not a priority at this time
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