248The Use of Data and Six Sigma Principles to Guide a Complex Falls/Blackout Clinic

Abstract

Background: As part of the Waterford Integrated Care for Older People Project [WICOP], the Complex Falls/Blackout Clinic launched as a new pathway on April 4th 2017. We developed a database to refine the pathway in line with Six Sigma principles. Methods: Using Filemaker Pro Advanced Version 15, we created an electronic clinic proforma, with separate interfaces for the administrative staff, geriatrician, clinical nurse specialist and physiotherapist. We designed unique interfaces to guide standardised assessments by the multidisciplinary team [MDT] whilst also avoiding duplication. Following MDT discussion, the interfaces combine to form a summary record of the patient's assessment and recommended interventions. This summary record is sent to the general practitioner. The data captured feeds into a live searchable database of patients that is automatically updated with every clinic attendance. Results: The data revealed most of the referrals came from general practice (22/28) so we sent formal correspondence highlighting the service to hospital departments and community occupational therapists and physiotherapists. Only 14/28 patients were high-risk fallers (unable to get up after a fall) so we changed our referral form to identify more suitable patients. Using the Fried Frailty Score, 6/25 patients were frail. Conclusion: In line with Six Sigma, the database allows us to define, measure, analyse, improve and control the processes of the clinic in real time, thus ensuring that we are seeing predominantly pre-frail high-risk fallers who are best served by this multidisciplinary clinic. The database captures the community services recommended and therefore what onward demand we are creating for the already stretched community services. We plan that the database will be accessible by community-based healthcare professionals. We envisage similar systems for the other pathways of WICOP (frailty, memory, movement disorders) with the hope of creating a register of patients to aid transition between pathways should patients require it.