Reducing Hospital Attendances for New Vascular Referrals While Improving Risk Factor Investigation

Vascular disease is strongly associated with advancing age. As Ireland’s population gets older and the prevalence of other risk factors such as diabetes increase so too does the incidence of vascular disease. In an already heavily burdened system it is important that all processes operate efficiently without sacrificing quality of care provided to the patient. A key metric of quality care provision is patient satisfaction. Something which is negatively impacted by repeated hospital attendances. This quality improvement (QI) project plan proposed to reduce the number of attendances new vascular referrals made to the hospital by identifying areas of waste within the current system. A more proactive screening of modifiable risk factors such as diabetes was also proposed. The DMAIC (define, measure, analyse, improve, control) framework as set out in the Lean-Six Sigma QI model was utilised. After stakeholder analysis, process flow mapping and driver diagram production, it was determined that, improving inter-departmental communication and standardisation of triage and investigation ordering were high yield targets for improvement. Patient attendance records and imaging information showed that 39% of new patients were attending without relevant scans. An improved process flow map was proposed which would conservatively see attendances reduced by four, and by creating a standard pathway for imaging investigation see patients receive an improved quality of care when they attend. By liaising with the phlebotomy department and adapting a protocol already in place by another department, risk factor bloods were added to the proposed patient investigation process.