Setting up and rolling out a project across an NHS area requires hard work and dedication from everyone involved, which is why you want it to be as successful as possible. A PDSA is an excellent way of testing whether a project will work without long-term commitment.
What is a PDSA?
The Plan, Do, Study, Act (PDSA) cycle is a model for improvement which enables the testing of changes on a small scale, building on the learnings before wholesale implementation.
Plan: This stage focuses on the change to be tested and what it aims to achieve or improve, for example, the specialty Advice & Guidance (A&G) line to set up. Our team of Account Managers will work with you to understand your needs and how we can help. We can create bespoke outcome sets to ensure that the data will be as detailed and accurate as possible.
Do: The test or change is then carried out. We will launch the A&G line for a set period, we recommend 6 weeks, which gives us enough time to measure its success. We will work with our Marketing and Communication team to launch the service and spread the message to user groups to ensure awareness and uptake of the service.
Study: Based on the measurable outcomes agreed upon before launch, we take a consultative data-driven approach, and will collect extensive information before and after the change. We also carry out reporting to evaluate the impact and what was learned.
Act: Lastly, depending on the results, we can plan additional changes in the cycle, prepare for full implementation or reflect on why it was unsuccessful and what we can learn.
A PDSA in action:
In February 2021, the first Frailty PDSA initiative in Coventry and Warwickshire was activated with the aim to assess whether the West Midlands Ambulance Service (WMAS) crews were able to access Elderly Care consultants in a timely way. Upon conclusion of the two-week PDSA, calls were answered in 34 seconds, with 75% of calls being answered by the first consultant on the rota.
A month later, the second Frailty PDSA began for an extended period of two months. The South Warwickshire Foundation Trust (SWFT) Frailty Service provided early specialist intervention for patients that may need conveyance to ED, in an effort to prevent unnecessary admissions and/or ED attendance.
How did this work?
1. An ambulance clinician from WMAS visited a frailty patient considered for conveyance.
2. The ambulance clinician called the SWFT Frailty Service for a clinical triage to be conducted by an elderly care consultant.
3. A decision was then made to determine the next and best outcome for the patient, all of which was captured in Consultant Connect for reporting and learning purposes.
Outcomes revealed that 45% of calls resulted in an avoided admission/attendance to ED. The other 55% of calls resulted in necessary admission/attendance to ED or transfer to the Frailty Assessment Area (FAA) following specialist A&G. In the two-month PDSA period, the Frailty Team answered more than 200 calls from WMAS.
From PDSA to integrated pathway
As a result of the successful PDSAs, the Frailty Service at SWFT is now a fully-fledged integrated pathway.
The success of this is reflected in our partnership with the integrated Frailty Service in SWFT:
- Being shortlisted for the HSJ’s 2023 HealthTech Partnership of the Year Award.
- Featuring in NHS England’s latest delivery plan for recovering urgent and emergency services as an example of how to expand and better join up new types of care outside of hospital.
Key outcomes
So far, this pathway led to a 50% reduction in ambulances conveying patients over 75 to ED, giving frail older adults an alternative to hospital admission. In addition, the trust makes follow-up calls to all patients discharged over 75. These calls provide an opportunity to see how the patient is, answer any questions they may have and have proven to reduce re-attendances from 15% to 3%. It also grows relationships with and upskills community teams.
We recently went on-site to capture first-hand from clinicians and staff at SWFT and WMAS how the integrated frailty service is helping to ensure frail older adults in crisis avoid unnecessary hospital admission. Watch the short video below:
If you would like further information on arranging a PDSA for an Advice & Guidance line in your area, please contact us on 01865 261467 or hello@consultantconnect.org.uk
