By Dr Satya Raghuvanshi, Head of Clinical, Accurx.
In his latest Elective Recovery bulletin, Jim Mackey, National Director for Elective Recovery, recorded that waiting lists in NHS trusts across the country are “not as accurate as they should be, with multiple entries apparent in the data.” To many, this could sound like simply an administrative problem. However, we know first-hand that this issue strongly contributes to the pressures felt by trust leaders and staff who manage waiting lists and who have limited ways to understand and prioritise the patients on them.
In his bulletin, Mackey also spoke of “significant reductions in list size resulting from active validation.” To those unfamiliar with the term, ‘validation’ is the process of evaluating whether patients on waiting lists still require care. As Mackey indicates, validation has shown to be very effective in helping trusts manage and reduce their waiting lists – but particularly so when using simple tech.
But what is the best way to go about validation with tech? And what principles should be followed to make an impact as quickly and effectively as possible?
Since June 2022, University Hospitals of Leicester (UHL) has been using Accurx’s tech for waiting list validation, to help reduce their elective backlog. The results have been significant. We have helped UHL to message 140,000 patients and identify 14,100 patients who no longer require treatment and who can therefore be removed from their waiting list. This has enabled the trust to tackle their elective backlog head on and provide quicker care for other patients in need.
It all started with an initial pilot of our patient messaging software, which has now spread to nearly 60 services at UHL.
A simple SMS message
Like many trusts, UHL’s previous waiting list management process was time-consuming and saw them use automated phone calls and letters. This made it incredibly difficult to validate high volumes of patients, which in turn led to increased waiting times. It was also difficult to track appointments and follow up with patients who didn’t respond. To tackle this, UHL has been using our software to communicate with patients waiting for care via SMS to see if they still need their overdue first or follow-up appointment.
Once the patient receives the SMS message, they can reply with a simple ‘yes’ or ‘no’ answer within seven days as a single response only. This removes the risk of patients sending multiple reply messages. Patients who respond ‘no’ are asked to give a reason that their appointment isn’t required, allowing for important information gathering around their care. Patients who respond ‘yes’ are given the option to move onto a digital Patient Initiated Follow Up (PIFU) pathway through Accurx, to help free up outpatient slots and further tackle the elective backlog. All patient responses go straight into the inbox of the healthcare professional or team, ensuring none are missed.
At Accurx, we believe this kind of simple tech can be leveraged by more trusts to manage waiting lists more easily.
Spreading the benefits
Through the learnings and successes achieved in the validation work with UHL, the Trust has demonstrated the benefits that can be achieved through simple text messaging to patients. It has also shown how much easier this method is than phone calls and postal letters. Many UHL services are now also starting to use Accurx for other use cases, spreading the benefits of the system to more staff and patients across the Trust and further contributing to their elective recovery goals.
Other use cases include SMS appointment reminders which are helping to reduce DNA rates in services, many of which are over 10 percent. This is something Mackey also notes in his bulletin, stating that “last year 7.5 million appointments were lost due to missed appointments – more than the size of the waiting list.” Simple tech like automated appointment reminders can substantially reduce DNAs within a matter of weeks.
Other new use cases for SMS at UHL include Patient Initiated Follow Up (PIFU) to help services manage their PIFU patients digitally. Currently, nearly 1,000 PIFU links have been sent out to patients across Dermatology, Thoracic Surgery and Rheumatology. This will further help to reduce waiting lists by reducing unnecessary follow-up appointments for patients in active treatment.
Improved experience for staff and patients
The staff at UHL say they have noticed a much-needed change in their day-to-day work since implementing SMS messaging. It has lessened their workload and improved their workflows, leading to an increase in morale. The quick and easy communication enabled by SMS eliminates the need for time-consuming methods like letters and phone calls, creating a more efficient process. Additionally, the direct response from patients through SMS forms a stronger feedback loop for care teams.
One Dermatology admin team member has said that being able to communicate with their patients via text is a “game changer”, and another team member from the Rheumatology team said that “using text messaging is the easiest way to get in touch with patients. This system is a breath of fresh air.”
Patients say they have also benefited from the waiting list validation process. The direct communication with the hospital through SMS messaging ensures that patients are no longer left feeling uncertain about their care. This helps to alleviate any anxiety they may have had and reassures them that they have not been forgotten, despite the wait time. Additionally, this communication empowers them by giving them a greater sense of control over their care.
In terms of combating digital exclusion, if patients can’t respond via SMS, they can respond on a computer, iPad, or tablet. If a patient can’t or doesn’t respond, they remain on the waiting list and will be clinically validated or contacted by phone. Some patients will still receive letters, where patient access to digital or technology is a factor. Our behavioural science team also contributed to the wording of the messages sent by UHL, to increase patient response rates and satisfaction.
Tech for now
Mackey feels “there is high confidence that [waiting list validation] can be undertaken in parallel with other pressures”. It’s worth remembering that technology doesn’t have to be viewed as something to implement later down the line or a possibility that exists far off on the horizon. It can be a solution that trusts adopt with minimal disruption.
In fact, when resources are so tight and pressures are so high, there’s a need to move even quicker. This is where simple solutions like SMS come in. These solutions can quickly have a significant impact on managing waiting lists, improving communication with patients, and ultimately providing better overall care. Technology doesn’t have to be a luxury, but a simple solution that can help to streamline processes and improve staff and patient experience in the present, not just in the future. Waiting list validation is just one example of how technology can be implemented in parallel with other demands to improve the overall care provided by trusts.