Managing patient flows at St Thomas' Hospital

One of the busiest hospitals in the country recently improved the staff’s working environment as well as the patients’ experience. At the same time, management is getting vital statistics used to optimise staffing and meet targets. The pharmacy and the phlebotomy department at St Thomas’ Hospital are both using Patient Flow Management.

The setting
One of the largest hospitals in the country, St Thomas’ in central London is also a major teaching hospital. In addition, it has several specialist clinics and as a result the phlebotomy department is extremely busy. As St Thomas’ has the only lupus clinic in the country, patients come from all over the UK for blood tests, sometimes several times a month over many years. The phlebotomy department serves up to 400 patients per day. In addition, staff from the department see around 200 patients per day in the wards and at surrounding GPs’ clinics. The number of patients is steadily increasing as the hospital takes on the services of even more GPs’ surgeries. The nearest other phlebotomy department is at Guy’s Hospital but as it closes at 1pm, St Thomas’ has the only full time, walk in blood clinic in the area.

The past
With just an old ticket machine installed, the staff in the phlebotomy department had very little control over the patient queues. “I even had to tie up the old ticket machine with a string in order to keep it together sometimes,” said Enid Rayman, Phlebotomy Manager. In addition, the patients found it frustrating that some people with priority ratings were clearly called before others. The only way for staff to tell the patients they were next, was to go out in the waiting area and call out. “We sometimes had to shout to make ourselves heard over the noise in the waiting room,” Enid said. “We were hoarse from all the shouting sometimes,” she said.

The solution
Already in use in the pharmacy, a Patient Flow Management solution was the answer. The system has four priority categories, starting with chemotherapy and radiology patients. The second priority is patients who are scheduled for surgery the same day. Next are children and last, routine blood testing.
When patients arrive with their referral letter, they match the information on their letter with the category on the ticket machine. The system ensures the chemotherapy patients are automatically given priority and called before all other categories. Before arriving in the department, the patients are informed which category they belong to and what priority they have, so expectations and reassurances are set in advance.

“The tickets create peace,” Enid said. “Patients who come in for routine blood testing don’t have to see others cutting in front of them as they are slotted into a different category automatically,” she added. Patients keep track of the ticket numbers in their own category, and don’t have to worry about the other categories being called forward. Staff call patients forward for blood tests by using a keyboard, automatically showing the next ticket number in the relevant category on LED screens in the waiting area.

Patient experience
These days there is no stress in the department, even on the busiest days. Knowing they are in the process as soon as they take a ticket, the patients can relax, sit down, watch television or read whilst waiting. “We have many regular patients who come in year after year, and we can see that they appreciate the improvements,” said Enid. “The statistics generated by Q-Matic tell us that we have cut down the waiting times,” she said. Installing Patient Flow Management was part of a major refurbishment programme and the whole department is now a light and relaxed environment.

Management information
The statistical information generated by the system has allowed Enid to take appropriate actions in order to optimise staffing and patient service. “As the system tells us the number of patients visiting and how long they have to wait, we can easily predict our peak times,” she said. “As a result, I have been able to adjust the staffing to accommodate the volume of patients,” she said. Nowadays, staff who leave the department to collect blood samples in the wards are limited to visiting two wards at a time during the busy periods between 10am and 2pm. Before, there was no limit and consequently there could be extremely busy periods in the department but less staff to handle the volumes of patients.
Other management benefits include the ability to see how much time each member of staff spends with a patient. Thus the department’s productivity and efficiency is being monitored and as a result, Enid can manage the staff more effectively.

Going forward
Continuous training and follow up is taking place to make sure the department gets the most out of its system. Furthermore, management is looking to install a new voice function to accommodate patients with impaired vision. The system will also be continuously fine tuned to match any changing circumstances such as increasing volumes of patients. As the system collects data over time, the department will be able to see trends in waiting times, patient volumes and productivity over the years and can use these statistics to meet their own targets.

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