Hello, my name is Gary McDowell, and I’m a Reader in Clinical Science at Manchester Metropolitan University. Here, we are going to discuss an example of an innovation project undertaken by a healthcare scientist with colleagues in the Emergency Department. In emergency medicine, women of childbearing age often wait longer in the Emergency Department for medical imaging and diagnosis due to delays in obtaining pregnancy test results. In this project, we set out to determine if pregnancy testing at the point of care would improve patient flow in the department and improve the patient experience. The team was made up of a part-time PhD student, an Emergency Medicine Consultant, a Clinical Research Nurse, a point-of-care testing coordinator from the lab, and an Industry Representative.
I’m Dr. Martin Stout. I’m a Clinical Academic Cardiac Physiologist based jointly at Manchester Met University and University Hospital of South Manchester. Historically, patients presenting to General Practitioner surgeries with typical stable angina chest pain are referred into secondary care rapid access chest pain clinics. These clinics are designed to promote rapid access to specialist cardiac practitioners who can assess, diagnose, and potentially treat significant coronary disease in a ‘one-stop’ clinic.
Given National Institute for Health and Care Excellence’s guidance, together with operational issues, for example, lack of specialist staff, limited diagnostic services available, additional demand on already stretched services, many of these clinics do not provide the most sensitive testing for a given pre-test probability of coronary disease, are unable to offer any specialist tests, or cannot facilitate ‘same-day’ diagnostics for these patients. As such, many patients do not receive the correct diagnosis and treatment until they have been on further outpatient waiting lists for both diagnostics at consultant led clinics. These delays potentially can result in further morbidity, psychological distress, and ultimately mortality from untreated or unrecognised coronary disease.
The University Hospital of South Manchester developed an innovative patient pathway using current National Institute for Health and Care Excellence’s literature and also pilot data from across Greater Manchester– created a consultant’s health care scientist led model to provide ‘same-day’ access to all required diagnostics, specialist staff, and hence ‘same-day’ treatment or further referral if needed. I’m Clare, I work as an Audiologist for Wrightington, Wigan, and Leigh, an NHS Foundation Trust, at the Thomas Linacre Centre. So the project we developed was to implement hearing aid maintenance classes for hearing aid users with earmould fittings. I work in the Audiology Service at Wrightington, Wigan, and Leigh, an NHS Foundation Trust. We provide Adult Audiology Services to the whole of the Wigan borough.
These services include hearing assessments, hearing aid fittings, follow-ups, repairs, Tinnitus management, Balance Assessment, and Hearing Therapy. The aim of our project was to develop small group sessions which could be attended by patients, relatives, friends, or carers to demonstrate hearing aid maintenance with the aim to reduce the amount of clinical time spent doing this, We felt this was necessary for a number of reasons. First of all, hearing aid users who wear hearing aids with earmoulds need to attend the department for a 15 minute maintenance appointment every six months. This appointment involves replacing the tubes on their hearing aids. Over time, the soft tube between the hearing aid and the earmould goes hard. And this prevents the sound being transmitted as effectively.
This can result in the sound quality from the hearing aid becoming quite poor. On some occasions, the tube can fall out completely, meaning the patient cannot use the aid at all. In the last year, Audiology have completed 6,613 maintenance appointments, which equates to 1,653 hours of clinical time. The Audiology Department is becoming increasingly busy. And by empowering our patients or family members to look after their own hearing aids, we felt we could spend this clinic time developing new services, reducing waiting times for other appointments and utilising staff skill sets properly. Secondly, being without a working hearing aid has been proven to have a negative impact on quality of life.
Sometimes patients may have to wait a few days to get an appointment with the audiology department, therefore, unfortunately prolonging the time without an aid. Patients or family members being able retube the aid instantly reduces this time. Being able to hear well is vital for patient safety and well-being. They need to be aware of their surroundings and their environments. By teaching them to do this, we’re reducing the effects of their disability, promoting their safety, and improving their standard of living. Thirdly, reducing the amount of visits to Audiology can help reduce any stress or anxiety felt by the patient at having to attend more hospital appointments and gives them the confidence to manage their own hearing aids.
Finally, in nursing or residential homes, it has ensured patients who are unable to attend the department can have their hearing aid fixed quickly by carers or family members. Patients with dementia and other complex needs often access our service more. And being without a working hearing aid can cause people to become isolated. There’s currently a large amount of research regarding dementia and unmanaged hearing loss. The process of servicing and retubing hearing aids is relatively simple. And with some basic teaching, we felt many of our patients or their significant others would be able to successfully complete this task.