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N812 Re-designing the IBD nurse service for children and families in Glasgow using digital working – a tertiary centre experience

Garrick V., Curtis L., Richmond L.

Children's Hospital, Glasgow, United Kingdom

Background

In June 2015 the Children's Hospital in Glasgow moved site. This process involved a move to “paper lite” and agile working practices including the use of “hot desks”. Historically the Glasgow IBD Nurse Service ran a telephone advice-line which was recorded and triaged using a paper template. Calls were answered in an ad hoc fashion (usually between clinics or other patient related contact) and paper documentation was used.

Prior to the move, parent and patient email contact had increased. Many parents and young people had expressed a preference for email contact as being more flexible and easier to refer back to than telephone contact. We introduced a combination of email and telephone clinics documented digitally to produce a more robust process for dealing with patient contact in the paper lite era.

Methods

A generic IBD Nurse email account was created using a secure server to re-direct all patient related contact. All patients are given the IBD Nurse email address at diagnosis and offered this as a means of access for the service. A generic template email is sent to all new contacts. Implied consent is obtained when the parent or young person replies to the mail. The email signature gives clear advice on IBD nurse service access including rapid access and all contact details. Emails are answered daily between 1pm and 4pm and all communication is “cut and pasted” into the patients electronic record. Advice-line messages are picked up at 11am and 3pm daily and sent to the generic IBD Nurse email by admin staff. These messages are “cut and pasted” into the electronic shared calendar and triaged using a colour coded system. Red: not dealt with. Amber: in progress. Green: completed and outcome documented. All adviceline calls are responded to by email or in the IBD Nurse telephone clinic.

Results

We compared our processes before digital working was implemented to those now used. We also audited the number of emails sent from March to August 2016.

Table 1

Before moveAfter move
IBD Nurse advice line calls transcribed onto paper for triage.Advice line calls now collated electronically and stored in shared electronic clinical calendar. Calls are colour coded to illustrate when they are complete – `Traffic light' system used.
Adviceline calls responded to in ad hoc manner.Telephone clinics now used to respond to clinical calls and emails when necessary. 2 clinics per week. 6×30 min slots at each clinic. Allows time to complete full patient episode including documentation, dictation and co-ordination of any other events.
Patient emails received in ad hoc manner direct to IBD nurse personal account. Reactive management.Patient specific contact now directed to generic IBD nurse email account and responded to in daily email clinic. All communication `cut and pasted' into electronic patient record.

Table 2

MonthNumber of patient emails sent
March345
April347
May223
June285
July275
August335

Conclusion

Moving to the new Children's Hospital required a review of working practices. We present our experience of implementing digital working into the Glasgow IBD Nurse service. This required significant service redesign but has resulted in a more proactive and organised approach to dealing with patient contact. Our expectation is that it will also produce more robust data for future audit.