Learning Disability Services

Project

Riverside Lodge Day Service

Leads:  Ivy Winters, Service Manager; Sharon MackKenzie, Matron.

 

What was the problem?

Riverside Lodge (RSL) day service is a specialised service which accepts individuals who have a diagnosis of a learning disability, 18 years old and are CHC (Continuing Health Care) funded. RSL will accept individuals with complex care and/or challenging behaviours.

The service provides a nurse led day service to three individuals and due to no new referrals, it was agreed that the service is not sustainable, and resources could be utilised in other areas.

 

Aim

Decommission the service and redirect savings from the block contract to fund community-based transition and specialist care initiatives aligned with the Transition Care Business Case.

 

What did we do?

• Completed an options appraisal and agreed to decommission the service and redirect savings from the block contract to fund community-based transition and specialist care initiatives aligned with the Transition Care Business Case.
• A swot analysis was completed and analysed.
• The proposal was presented at the Transformation Board and Divisional Quality and Safety Board.

 

What are the benefits for patients and staff)?

• Riverside Lodge can be used as a community hub which would support Locality working and the clinicians return to base.
• Workforce planning: Nurses could support community areas and Health Care Assistants (HCAs) could support IST / community services.
• Monies could be allocated to implement the development of other services such as the Transition Team, supporting young adults to LD services.
• Cost savings: vehicle and transport costs.

Measures used

• Feedback from service users and staff.
• Budget review.

 

Qi tools used

• Options appraisal.
• SWOT analysis.
• Impact assessment.

Project

Nurse On Call.

Leads:  Melissa Baker, Operational Business Manager; Robert Atambo.

 

What was the problem?

The nurse On-Call rota is made up of a variety of staff who work in Community, Physical Health, Transforming Care Partnerships (TCP) and Bedded area teams, and is supported by the psychiatry On-Call and senior On-Call, the service is having difficulty filling the rota.

Aim

To review Nurse On Call rota, with the aim to step down the community team out of hours cover.

 

What did we do?

• An initial options appraisal, quality impact assessment, and equality and human rights assessment were undertaken and presented at various meetings.
• A further options appraisal, quality impact assessment, and equality and human rights assessment were undertaken and presented at the On-Call Working Group and Divisional Leadership Team Meeting. 
• Approval was given for the Nurse On-Call process to be stepped down in stages.
• An action plan was created following the away day and actions distributed to members of the On-Call Working Group.

 

Measures used

• Audit.
• Patient feedback.
• Staff feedback.
• Observation.

 

Qi tools used

• Options appraisal.
• Feedback.
• Quality impact assessment.
• Equality and human rights assessment.
• Action plan.

Project

Referral Pathway

Leads: Alison Whalley, Interim Professional Lead Nurse; Lisa Whitehouse, Advanced Clinical Practitioner

 

What was the problem?

The Learning Disability service was unable to triage new referrals resulting in a delay in accessing specialist learning disabilities services potentially impacting on patient safety due to increased risk of clinical harm. External referrals that were received were unable to be processed in a timely manner due to capacity in the Triage team and the amount of information collated and assessments completed which were unnecessary for Triage and prevented the multi-disciplinary team (MDT) making informed decision around acceptance, non-acceptance and signposting referrals.

 

Aim

To review triage processes, reducing waiting times for service users awaiting triage and support locality MDT to become more robust and streamlined.

 

What did we do?

• A time sensitive rectification plan was implemented whereby a majority of clinicians were assigned and allocated a case to Triage.
• A literature review undertaken with the support of the Smallwood library around the subject matter of learning disabilities, adult services referral process.
• Contact made with other learning disabilities services nationally to ascertain there processes around external referrals, triaging and referral documentation.
• Process maps of current and future state were created.
• Created an excel spread sheet to collate all referral information including KPIs .

 

What are the benefits for patients and staff)?

• Robust referral pathway from the point of referral to acceptance at locality MDT.
• Improved patient and carer experience regarding effectiveness and response in terms of wait and process times.
• Clinical risk has been reduced due to key performance indicator (KPI) being embedded into process and there is no longer a waiting list for triage.
• Triage huddles implemented to support allocated of triage task and review of KPI.
• Increased staff satisfaction regarding process and referral documentation as clinicians have been involved in the process.

 

Measures used

• Feedback.
• Waiting lists.
• Audit.

 

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Process Mapping.
• Gantt Chart

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