York & Scarborough NHS Trust
Rethinking Urgent Referrals for York & Scarborough NHS Trust
The York and Scarborough NHS Trust Core Team, which is made up of representatives from the Trust and both participating hospitals; York and Scarborough, commissioned a project in February 2021 using the Yorkshire and Humber Discovery and Development Services Framework, to redesign the urgent referral actions service.
The project brief asked for a service design approach to examine the existing urgent referrals process at the Trust, and in particular the relationship between GP’s and Consultants, and identify opportunities for improvement. The project delivery team was formed by dxw and Mima.
The brief entitled, Urgent Referral Actions Service Redesign asked for a service design approach to examine the existing urgent referrals process at the Trust, and in particular the relationship between GP’s and Consultants; and identify opportunities for improvement.
The goals that we set for this discovery are:
• To map the Trust’s current urgent referrals service including problems and pain points and things that are going well
• To envision a future service including recommendations, concept designs and prototypes for the highest value improvement ideas
We ran an extensive discovery process to talk to a diverse range of GPs, clinicians across SDEC/Acute care, emergency departments, diagnostics and specialist consultants. We also talked with bed management / patient flow teams. From these conversations we built a picture of the as-is service both from a patient journey and the back-of-house operational and clinical perspective
From the discovery insights, we ran a series of design sprints to address a focused problem statement:
• We have learnt that when GPs are concerned about patients near close of business, they are sometimes forced to send them to ED because other referral pathways are not available. This can result in long waits and unnecessary admissions.
• How might we provide GPs with alternative care plans prior to referring to ED, having agreed processes in place to speed up diagnostics within ED or better supporting 'urgent' booking into SDEC or similar?
The sprints generated two ideas to prototype:
• Rapid Advice – a system to provide same day advice to GPs deciding which next step to take
• Virtual Ward – a system to support patients waiting at home while next day urgent care is organized
The design concepts were prototyped as digital solutions and feedback gained from stakeholders. This feedback will be used to determine which aspects of the concept should be taken into a next phase to develop the ideas to an MVP.