Learning Disability Services

Project

Reducing the number of patients breaching clinical prioritisation for psychological input within the Learning Disability (LD) Services division.

Leads: Dr Gemma Lees-Warley, Clinical Psychologist; Dr Radha Bisnauth, Clinical Psychologist; Dr Cathie Swainland, Clinical Psychologist

 

What was the problem?

The service was facing a critical issue with a growing number of patients breaching, meaning they were waiting beyond safe timeframes for assessment or intervention, increasing the risk of clinical harm.

Staff meetings to review cases were becoming increasingly time consuming, often lasting over 5 hours, with 45+ breaching patients in addition to a regular caseload of 140+ patients.

It became clear that a more efficient and structured process was urgently needed to:

• Identify patients at greatest risk,
• Prioritise timely access to care,
• Free up clinical time to respond to post-COVID service pressures.

The goal was to implement a system that maintained patient safety while improving operational efficiency and supporting staff wellbeing.

 

Aim

To reduce the total number of patients breaching their clinically determined timeframe for psychological input from 45+ to less than 10 by September 2023 in the LD Psychology Service.

 

What did we do?

• Introduced a separate “dashboard review” meeting for managing breaches outside of our team meeting. This freed up time to discuss clinical cases in the team meeting.
• Consulted a business intelligence manager about the data available to us.
• Risk and care-plans were reviewed for all patients breaching and nearing the breach date and a standardised decision-making process was introduced to develop action plans.
• The dashboard meeting had a mix of qualified and unqualified staff, which was more cost-effective.
• Once the process was embedded, the number of staff attending the dashboard meeting was further reduced, freeing up more clinical time for qualified psychologists.
• Identified areas of record-keeping that could be refined to make information easier to find and use for decision-making.
• Developed a standardised process of reporting to management so that patients most at risk were easily identified.

 

What are the benefits for patients and staff?

• Although the psychology caseload size remained largely unchanged, the number of breaches decreased significantly, achieving the target of fewer than 10 breaches within the set timeframe. This improvement meant that clinical risk were being addressed more promptly and effectively.
• The time required for the weekly dashboard meeting was reduced from approximately 5 hours to just 1 hour, freeing up valuable clinical time.
• As breaches declined, less time was spent discussing them during team meetings, which had a positive impact on staff experience. This allowed for more proactive and reflective case discussions, enhancing team collaboration and clinical planning.
• The process has been sustained over time. While occasional increases in breaches have occurred, due to rising referral rates and staffing changes, the systematic approach has ensured continuous clinical oversight. This has provided clarity on which patients are most at risk and helped the team prioritise clinical resources effectively.

 

Measures used

• Waiting time data was used to record of the number of breaches.
• Measures were introduced to record the length of the dashboard meeting and number of clinicians attending, the number of new patient breaches, the number of existing patient breaches, the number of patients reviewed in the meeting, the total psychology caseload and the length of the weekly psychology meeting. 
• The time spent on the QI project itself was also recorded (for example, meeting to plan the project, fishbone diagram).

 

Qi tools used

• 5 W’s & 2 H’s
• Fishbone diagram
• Driver diagram
• Process mapping
• Run charts
• Statistical process control (SPC) charts