How we used PLICS to help reduce unnecessary pathology testing in Respiratory

Author: David TunstallDate: 9 months 3 weeks Ago

Working as part of a Costing Team generating PLICS (Patient Level Information & Costing) information it’s always exciting to be able to draw upon the wealth of information we hold and use it to work with clinical specialties here at Leeds Teaching Hospitals.
 
Recently I’ve been collaborating with the Respiratory Team to work through their activity data, looking for opportunities to improve efficiency and reduce waste.

Most of this work has been with Dr Ian Clifton, the Respiratory Clinical Lead. His knowledge of the service, and commitment to improving the quality of care for his patients, provided the vital insight and leadership that helped turn data in to action. 
 
Having reviewed the information available we decided to focus on pathology tests. With over 103,000 thousand ordered in the previous year, the challenge I faced was how to turn such a large volume of “data” in to useful information?
 
So I set about creating my key metrics:

  • What tests equate to 80% of the total activity.
  • Is any clinician ordering more than 20% of any one test compared to peers.
  • Average number of tests/procedure.
  • Individual episodes where tests were being repeated.

The importance of having clinical engagement is that the Lead Clinician started to see patterns straight away in the repeat testing information, generating questions such as:

  • Clinical guidelines recommend 48 hours between blood tests, why is that patient being tested every day?
  • If you’re tested and found to be allergic to cats last week, you’re probably still allergic this week, so why is the patient being tested again when this should be in the patient notes?

Fast forward a couple of intervening discussions to set out what was needed and how it was going to be used and the project was set up.

  • The Consultant identified the pathology tests for monitoring, each with a trigger point ranging from 48 hours to 365 days.
  • Using the PLICS system and a little excel knowhow a monitoring pro-forma was set up to show the volumes of repeat tests, and just as importantly both who ordered the test and from what location at an individual patient level
  • And finally, a plan was set out to get this information reviewed by the service.

 
Putting it in to practice.
 
This is where Registrar Dr Braithwaite plays a pivotal role on the wards and across other clinical areas.
Whether it is about promoting good practice, raising awareness amongst her colleagues or looking at where communication processes need to be improved her role is to address why these repeat tests are happening, and put measures in place to reduce them.
 
Examples of action already taken include posters in clinical areas and raising awareness of the issue with the new intake of FY1 Junior Doctors as part of their induction.
 
Being able to use PLICS to provide and update this information monthly makes it more accessible and easy to monitor than a traditional clinical audit. This means Dr Braithwaite has the information much quicker and can use it more effectively to make a difference.
 
From my perspective...

As a Finance professional I can fully appreciate how the changes are helping to reduce waste in Respiratory.

As a member of the Costing Team it’s great to see the work I’ve done being used to help highlight and address issues for the benefit of the service.

For me personally, it’s incredibly satisfying to know that the information I’m producing for this on-going project is contributing towards the improvement of patient care.