The HandsFirst trusts and health boards used the diagnostic tools below to develop change ideas which they planned to introduce to improve care for hand trauma patients.

Diagnostic exercises designed to gain a deeper understanding of hospital systems

• Efficiency: monitor theatre lists review ‘planned’ vs ‘actual’ cases that took place measure length of time taken for patient to move through (stages of) the pathway
• Value added: identify the potential need / value of additional training and education for staff members related to HandsFirst.
• Prioritise: process map the pathway to understand challenges and prioritise areas for improvement.

Change ideas being tested

1. Creating new capacity

• Existing facilities:  longer lists; Golden patient; reinstate MOPS room.
• New facilities/equipment:  clinic; theatre; mini C-Arm.
• New ways of working: location for procedures; dedicated lists.
• Staffing: revise job plans, recruit new staff, upskill existing team members.

2. New patient pathways/processes

• Joint working: work with local hospitals to create a regional approach/pathway; engage colleagues (within site and at neighbouring trusts/health boards and at other medical facilities) to streamline processes; improve the referral system e.g. an online referral system, a generic email addresses, use Apps.
• Improve existing pathway: e.g. for closed fractures.
• Create new pathways: e.g. for early and easy pre-assessment; to fast-track patients to surgery.
• New service/facilities/equipment: e.g. virtual fracture clinic; therapist-led hand fracture clinic; x-ray facilities in clinic; a block service.
• New information: e.g. create guidelines for access to the virtual clinic.
• New ways of working: review decision making e.g. include senior hand therapist; ensure consultants review cases; create smart text proforma for initial assessment; introduce an algorithm for triaging referrals to the service; introduce a daily handover meeting; increase membership at team/trauma meetings.

3. Reduce waste

• Environment: e.g. locate treatment rooms closer together to increase efficiency.
• Equipment: e.g. reduce use of instruments, drapes and single use plastic for hand trauma procedures in theatre.

4. Improve patients’ experiences

• Engagement: introduce patient experience questionnaires.
• Information: produce patient information leaflets.

5. Communicate with colleagues and build new relationships

• Create and share guidance on HandsFirst e.g. standards, referrals, treatment and pathway; raise awareness of the project with colleagues to improve buy in, for example at meetings and by displaying posters

For more information contact us handsfirst@rcseng.ac.uk.