Outpatient Documentation: 5 Ways Healthcare Organisations Can Enhance Their Processes
Clinical documentation is a significant element of outpatient care, with a great deal of important information contained within letters such as what happens next in the patient’s care, tests required, changes in medication etc. The processes by which this documentation is produced and how quickly that takes place (known as turnaround time) can therefore have a big impact on the timeliness of patient care. The burden of producing it also takes healthcare staff, both clinical and admin, away from other tasks. Therefore, any steps which can be taken to enhance the process should be taken, particularly where the demand is higher than ever.
The NHS Long Term Workforce Plan published in June stated that “the number of hospital outpatient visits have nearly doubled over the past decade from 54 to 94 million (at a cost of £8 billion a year)”.
Nearly all outpatient appointments result in at least one letter, typically to the patient’s GP whilst there can also be a letter to the patient, as well as other clinical documentation depending on the nature of the appointment. With NHS Digital reporting that there were 124.5 million outpatient appointments in 2022-23, it is clear to see the significance of clinical documentation within outpatients and the challenge that healthcare organisations face to keep on top of it.
Meanwhile, on 4 August 2023, NHS England wrote to all NHS Acute Trusts setting out the support and next steps for outpatient transformation, as well as requiring them to “provide assurance against a set of activities that will drive outpatient recovery at pace”. We feel that outpatient correspondence is crucial to achieving such a recovery and many healthcare organisations will need to enhance their processes to do so.
 Note that the NHS Long Term Workforce Plan figure relates to Attendances whilst the NHS Digital figure is Appointments.
5 Ways Healthcare Organisations Can Do This Are:
1. Document and understand the current end to end process.
As a starting point, it is important for Trusts and other healthcare organisations to have a complete understanding of their current end to end process for producing clinical correspondence. “Freeing up capacity and increasing productivity” was emphasised as a priority in NHS England’s letter and ensuring this full understanding of their process will allow organisations to identify any obvious inefficiencies which can be easily eliminated, as well as build a plan towards further enhancement of their workflow.
The risks inherent in the process should also be obvious once the process is clearly set out. Two Trusts were recently in the news for letters which they failed to send to GPs and patients numbering 24,000 in the one case and more than 400,000 in the other. Could this be just the tip of the iceberg?
2. Ensure there is visibility
Ideally, healthcare providers will have a clinical correspondence platform which shows the status of all outstanding letters on a live basis. However, we know that many sites have more than one workflow for producing their letters and many different systems involved. Therefore, having this visibility can be a challenge and often falls to Admin Managers to try to keep on top of in the form of a spreadsheet or similar. Again, this presents risk in terms of letters falling through the gaps between different processes which a platform with live reporting and advanced analytics can overcome.
3. Identify opportunities for standardisation
Many aspects of clinical correspondence include standard text which is repeated on a regular basis with amendments based on the specific circumstances of the patient. The most basic example of this is a standard physical examination. Standardising as much as possible of your process, and the clinical documentation itself, will save time for all involved – from the clinician dictating the document to the admin staff producing it, and everything else that is involved in between.
Again, NHS England recognised this in their letter suggesting “reducing variation in clinical templates” as a new approach “to increasing wider outpatient productivity”. The Professional Record Standards Body (PRSB), a Partner of ours, was established to develop clinical standards for health and care records. Establishing such standards has significant benefits both in terms of accuracy and efficiency.
Templates can be presented to authors at the point of dictating which they can then speak through, whether using speech recognition or digital dictation, resulting in standardised documentation across departments, divisions, hospitals or even trust wide.
4. Consider removing the typing from your admin staff’s workload
In March 2023, which is the latest data available, 112,500 vacancies were recorded across the NHS in England. At a time of ever-increasing demand, the workforce available is stable at best resulting in an ever-widening gap between supply and demand. Admin staff are therefore stretched to keep up with their workload which they often cannot, resulting in backlogs.
In our experience when backlogs start to accumulate, they quickly snowball as calls from GPs, patients, other departments in the Trust etc increase who are all chasing information which is contained in a dictated but not produced letter. Validating waiting lists and ensuring that RTT rules are complied with also becomes increasingly difficult when letters have been dictated but not typed.
Typing letters is time consuming and can take administrative staff away from valuable tasks such as progressing the patient’s care including booking diagnostics, follow up appointments, validation etc.
There are two proven options which Trusts can deploy to take this labour-intensive process off their medical secretaries’ workloads which are:
- Speech Recognition
In many cases, a combination of the two will be the most powerful combination and whichever is used, it is accuracy which will be the key to success!
5. Go paperless and implement electronic review
There are still many healthcare organisations where letters are printed once they have been typed for the consultant or author to mark up for correction by a secretary. This practice is highly inefficient due to the delays it causes and presents risk in hand marked amendments not being carried through.
Using a clinical documentation platform which enables electronic review will significantly increase productivity, eliminate risk and the need for paper copies, and reduce waste.
This blog has demonstrated just how important clinical documentation is within Outpatients Departments and the wide-reaching impact it has on the delivery of care. Where healthcare organisations have inefficient workflows, they are being put under huge pressure as more documents are pushed through them. Taking steps to enhance those processes is crucial in our view to delivering on the objective of Outpatient Transformation.