Royal Orthopaedic Hospital (ROH) have made significant strides to become more digitally mature and enhance their daily operational performance, with DrDoctor being a 'key partnership' in facilitating this change. Head of Digital Transformation, Gavin Newman, has been elated with the resulting impacts of the work in ROH’s Radiology department - something those at the Trust are “quite proud of”.

Digital Transformation has become somewhat of a “buzzword”, according to Gavin. The growing emergence of digital technology meant Trusts often get caught up with their endless capabilities, losing sight of what matters most - improving the clinician and patient experience. A strict line needed to be drawn: “the biggest challenge is remembering that it’s all about getting the basics right”. 

Challenge

Prior to implementing DrDoctor, ROH’s Radiology department were facing DNA rates of 7.4%, surpassing the current national benchmarks of 6%, projected to 5% in 2024. For MRI scans specifically, DNA rates were ranging between  10-16%, with patients typically waiting 5-6 weeks for their appointment.

Initial imaging appointments play a critical role at ROH in informing subsequent treatments and follow-up appointments. Failure to attend these appointments not only wastes scarce resources, but also increases the likelihood of unproductive or missed follow-up appointments. This was significantly disrupting patient pathways and placing a heavy burden on booking teams to reschedule appointments, adding an unnecessary backlog to patient waiting lists. 

The knock-on effect of missed Imaging appointments was also being reflected in compounding cost impacts. The average cost of a missed NHS appointment is ~£120, but this number is significantly higher in Radiology due to the highly specialised equipment and skillset required to effectively carry out the services. This cost is further compounded by subsequent missed follow-up appointments and rescheduling both in an appropriate manner.

Imagining services were making efforts to combat the issue, but with limited success. Letters were getting lost in the post, or failed to reach patients in time to inform them of last-minute imaging appointments. This prompted the search for a more streamlined, automated solution.

Solution

ROH set an ambitious target of reducing their DNA rate to 3% over the next 18-24 months to stay ahead of national targets. While DrDoctor had been effectively delivering results in other departments of ROH, implementing the same workflows to effectively reduce DNA rates in the Radiology department required a greater effort.

As radiology appointments were being managed in CRIS, rather than their PAS system (IPM), the first step involved integrating with CRIS. Using a custom orchestration workflow to link the patient IDs across both systems, ROH could then use DrDoctor for a single, simplified view of their patient information.

The Radiology department then began using Appointment Notifications to send out automated SMS reminders to patients 7 and 2 days ahead of their appointments, with confirmation messages sent when appointments were booked, cancelled or rescheduled. With Request-Based Rescheduling, patients could cancel their appointment or request to reschedule directly in the Patient Portal or via SMS. This ensured clinics were fully utilised if there were last-minute cancellations or changes to patients' appointments.

"It's had a huge impact on Radiology. DNAs could have been as high as 12%  - with Appointment Notifications, we've quickly seen a massive drop off. It's been great!"

Elizabeth Loach, Deputy Head of Imaging, Royal Orthopaedic Hospital

Impact

Coralie Duff, Associate Director of Operations at ROH, highlighted how DrDoctor's impact have helped the Trust meet two key NHSE standards. Appointment Notifications played a crucial role in transforming patient pathways, leading to ROH improving their 28-Day Faster Diagnosis Standards (FDS) benchmarks by 10% compared to previous months and see 99% of non-cancer patients achieve the 6 weeks target for their diagnostic appointment from referral.

"It isn't any coincidence that since DrDoctor, we've seen improvements across both standards in the last few months.”

Coralie Duff, Associate Director of Operations, Royal Orthopaedic Hospital

With DrDoctor, the Trust are now better equipped to effectively and efficiently reach and communicate with their patients. This has greatly improved the patient experience, with ROH seeing a big reduction in the number of concerns or complaints being raised by patents, who had previously expressed an interest in receiving texts regarding their appointments.

In just three months, DrDoctor helped ROH:

• Decrease DNA rates from 7.4% to 3%, dropping by over 80% for MRI scans.
• Decrease average patient waiting time for Imaging appointments from 5/6 weeks to 3 weeks.
• Save 35 admin hours (140 hours annually), enabling the Trust to better allocate their time and resources.
• Send 32,500+ appointment notifications to patients.
• >90% of patients rating the service as good or excellent.
• >1000 patients requested a change in their appointment via the Patient Portal, with a 34 hour average action rate on requests.
• Achieve ~£54,000 equivalent cost savings (£216,000 annually) from missed appointments avoided.

DrDoctor's solutions have given us the space to make sure our patients go through that patient pathway as safely, seamlessly and as efficiently as possible - all while keeping waiting lists short!"

Marie Raftery, Associate Director of Oxford Division 2, Royal Orthopaedic Hospital

ROH is also a GIRFT Elective Hub, an accreditation recognising NHS Trusts who deliver the highest standards in clinical and operational practice. Stricter pathway processes - supported through DrDoctor workflows - has allowed ROH to improve their delivery of Mutual Aid to other Trusts, ensuring patients receive timely care even when traveling from afar.

Next steps for ROH

Alongside using Radiology as a new benchmark for operational excellence for other departments, the Trust are now fully implementing a hybrid mailing solution with Digital Letters in 2024. ROH also plan to use Patient-Led Booking to empower patients to book their own appointments, and trial DrDoctor AI Linked Appointments to further reduce DNAs when related appointments are cancelled or rescheduled.