Case Study
Maidstone and Tunbridge Wells NHS Trust
Extending NHS111 First to
“Any to Many” Scheduling
At a Glance
Urgent & Emergency Care -
Direct Appointment Booking
• Bookings and referrals from NHS111and NHS111 Online
• Bookings from multiple referral sources including Primary Care, GPOOH and CAS
• Multiple schedules including ED,UTC, SDEC, MIU and Medical/Surgical Assessment
• Facilities to allow patients to book their own (Follow-Up) appointment
• Clear alternatives to patients waiting in ED.
About the Trust
Maidstone & Tunbridge Wells NHS Trust (MTW) is a large, acute hospital trust in the southeast of England serving a population of approximately half a million people. The region is typified by unusual social economics being home to both some of the highest earners as well as some of the most socially deprived people in the country.
On average, 14,000-16,000 patients a month visit the Trust’s two emergency departments (EDs) and Urgent Treatment Centres(UTCs). ED facilities are provided from Maidstone Hospital and Tunbridge Wells Hospital. At each site, there is a co-located urgent treatment centre. There are a further two urgent treatment centres that are managed out in the community. The UTC in Sevenoaks has a GP presence whereas the UTC in Edenbridge is managed entirely by advanced nurse practitioners.
Requirements for an NHS111 Appointment Booking service
Prior to deploying the NHS 111 appointment booking service at MTW, a number of requirements were identified. It was essential that any booking system would deliver:
• Interaction with the local NHS 111 service provider (SouthEast Coast Ambulance Service)
• Integration with a variety of EPR and PAS systems
• Complex scheduling capabilities
Our customers said:
We were planning to change our Emergency Department system to Allscripts Sunrise Clinical Manager. Therefore, we needed a solution that was going to be able to work with our current system but switch to the Allscripts product in the future. We also wanted the ability to link with any other system as our community partners don’t use Allscripts. We needed one solution for multiple operational systems.
Ultimately, we wanted to reduce the amount of duplicate or double entry into systems by administrative staff; we wanted this to be as seamless as possible from a direct booking point of view. We also required complex scheduling capabilities such as the ability to overbook and “overflow” bookings into our emergency department to best manage capacity across our ED and UTC network.
Nick Sinclair
Director of Operations for Patient Flow, MTW
The Solution
Technically approved by NHS Digital to provide Care Connect Provider services, WASP Software’s NHS 111 First Provider Scheduling solution sits in front of existing Urgent Care systems that have no scheduling capability.
The WASP solution has 2 key elements:
1. An outward-facing scheduler facility, which provides the facilities to offer multiple schedules into a range of services and
2. Inward-facing integration capabilities to ensure appointment and referral details are incorporated into schedules/work lists within ED system and stored within the patient record within the PAS/EPR. This entirely removes the need for administrators to input data/information from one system into another – which is a source of clinical risk.
Clinical systems integration
WASP Software has excellent commercial relationships with a number of key players in the clinical systems market and has deployed solutions with proven interoperability with Meditech, Dedalus (Lorenzo, iPM and PatientCentre), Altera and Cerner amongst others.
Key Features
• PPAS/ED System agnostic facility that allows any “Care Connect Consumer Service” to search and book appointments.
• Facility to allow booking from multiple sources into the same schedule, whether or not they are Care Connect Compliant.
• Scheduler facility to manage and publish a range of different schedules and adjust current capacity based on activity.
• Booking services to search, select and book a specific date/time.
• Integration services with NHS Digital Care Connect Broker services to allow booking from NHS111 including download of associated booking content.
• Integration into Emergency Department, PAS/EPR and UTC systems so users continue to use their usual systems.
• “Any to Many” Scheduling – any client including Care Connect, Web Browser and Mobile App can book into many schedules including ED, SDEC, UTC, MIU, Medical Assessment, Surgical Assessment and TIA/Stroke.
From a lesson-learned point of view, I think getting the Directory of Services correct can take time. We’ve worked with our CCG partners to refine the DOS based on the type of patients that are arriving at our UTCs, whether that be clinical presentation, geographical location, and priority of each service on the DOS versus another service.”
“NHS 111 keep referring, whether we have slots available or not in our UTCs and I think that’s really where the complex scheduling capability is key; so that we can either double-book or overflow into another service (generally ED), should that service become full.
Clinical and Administrative Benefits
There are significant clinical benefits to be gained as information gathered by NHS111 Call Handlers will now be available to the clinicians treating the patient; the information will be available in their local clinical systems.
From a lesson-learned point of view, I think getting the Directory of Services correct can take time. We’ve worked with our CCG partners to refine the DOS based on the type of patients that are arriving at our UTCs, whether that be clinical presentation, geographical location, and priority of each service on the DOS versus another service.”
“NHS 111 keep referring, whether we have slots available or not in our UTCs and I think that’s really where the complex scheduling capability is key; so that we can either double-book or overflow into another service (generally ED), should that service become full.
Looking to the Future
The challenge remains in trying to reduce demand on ED and to ensure patients are directed to the most appropriate service as an alternative to presenting unannounced at ED. Clearly alternative UEC services need to be available to deflect patients away from ED.
To this end, MTW will be introducing Same Day Emergency Care (SDEC) in 6 areas that can be booked through NHS 111 using WASP’s solution. The Trust will be offering SDEC in the following areas:
• ambulatory emergency care
• acute frailty, surgical assessment
• early pregnancy
• paediatric same day emergency care
• emergency gynaecology
The Trust is also planning to expand WASP’s booking solution to include handling direct referrals from GPs and other sources of UEC referrals, including the potential for patients to book their own appointments as a “safety net” in case of complications following discharge.
The Trust is also planning to expand WASP’s booking solution to include handling direct referrals from GPs and other sources of UEC referrals, including the potential for patients to book their own appointments as a “safety net” in case of complications following discharge.
Nick Sinclair
Director of Operations for Patient Flow, MTW