889 Quality improvement project to improve capacity in a Secondary Care Paediatric Allergy Clinic

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Objectives COVID restrictions had an impact to outpatient services.1 In our Paediatric Allergy Clinic, it led to increased waiting time for new patient appointments and increased number of overdue follow ups. We aimed to increase clinic capacity for new and follow up patients by reducing unnecessary follow ups appointments using quality improvement methodology and audit of our follow up criteria. Methods Two PDSA (Plan-Do-Study-Act) cycles were conducted, to look if patients were followed up in the paediatric allergy clinic or discharged, as per follow up criteria introduced. Follow up criteria were modified at each stage of the project following MDT feedback and review of audit results. Results In the first cycle, only 64.3% of patients seen in the paediatric allergy clinic were found to be followed up or discharged as per the criteria introduced in April 2020. In 35.7% of the patients the criteria were not followed. When this percentage (35.7%) was broken down further, it was noted that 30% of these patients could have been discharged or asked to arrange a patient initiated follow up (PIFU) at later key points of childhood. And for 70% of them, the follow up was requested in wrong time interval (for example, requested sooner than criteria suggested). Following presentation and reflection on the results, the criteria were modified and also incorporated new national standards, based on feedback from all the stakeholders. The second cycle (September 2022 -November 2022), revealed significant improvement in compliance with the now updated local criteria. This time, it was found that 80% of patients -compared to 64.3%- were either followed up or discharged from the ‘one-stop’ MDT clinic as per the Updated follow up criteria. Moreover, the overdue follow ups were reduced by 30% and the number of new-patient slots per clinic were increased. The option for PIFU and follow up in the dietetic clinic, were utilised more. Conclusions Ensuring adequate patient flow in an outpatient service helps avoiding overdue follow ups that potentially can have a knock-on effect to new patients. Following the first PDSA cycle, changes to the local criteria were implemented to improve practice and assist with patient flow, and the second cycle revealed improvement. This project highlights the importance of monitoring the current practice, identifying areas for improvement, and reassessing the changes implemented, to ensure equity of access to our outpatient service despite capacity pressures. Reference Hospital Outpatient Activity 2020–21, National statistics, England, Independent Sector Health Care Providers, Hospital Trusts, Regions, NHS Trusts, Country, September 2021, https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2020-21/covid-19-impact

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