Endocrine Abstracts

Introduction: In the Cardiff and Vale (C&V) Health Board, there are 203 children and young people (CYP) under the care of the multidisciplinary team (MDT), 96% of whom have T1DM. Every CYP is offered four outpatient clinic appointments every year, one of which is an annual review. The majority of them are situated in the University Hospital Wales (UHW) site, whereas the University Hospital Llandough (UHL) clinic was introduced in 2016 for easier access for the CYP from the Vale area.

Objectives: – To improve the patient journey in the CYP diabetes clinics in the C&V Health Board.

– To identify functional and process bottlenecks in the patient journey and suggest potential improvement methods to the MDT.

Method: 24 CYPs are followed through their journey in the UHW and UHL paediatrics diabetes clinics from registration to check out throughout a 6-week period (9 from UHW and 10 from UHL). The average time taken for each process and average total time taken are noted and illustrated on a patient journey timeline. Bottlenecks that interrupt the flow of the clinic resulting in delays are identified by direct observation and tabulated into a fishbone diagram.

Results: The MDT consultation takes the longest duration (30 min) out of all processes for both annual and routine reviews of both clinics – meeting the standard as stated in the National Paediatric Diabetes Network Guidance. The maximum time taken for the entire clinic process is 107 min in UHW and 57 min in UHL; the minimum time is 40 min and 31 min for UHW and UHL respectively. A total of 14 bottlenecks are identified which address the equipment and people involved, patient education, communication process, environment and general process of the clinics.

Conclusion: Several quality improvement suggestions, aiming to address the bottlenecks, are proposed to the MDT during a service meeting. Several interventions have been agreed to be implemented following discussion; evaluation on whether there are improvements to the efficiency, patient education and communication process in the clinics is required following implementation.