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Virtual Clinics for GDM

Want to know more? Visit the FCA websiteflowcoaching.academy

Gestational diabetes (GDM) increases risk of maternal and foetal adverse outcomes during pregnancy and affects about 5-8% of pregnancies. In six years, demand for GDM care has more than doubled, increasing the urgency to redesign services for women.

Women who develop GDM attend more obstetric reviews and attend diabetes specialist reviews at two weekly intervals. This leads to frequent and multiple hospital appointments during a pregnancy, compounded by the necessity for women to meet multiple professionals during each visit, which creates long waiting times.

From our Big Room activities, three key themes emerged and so guided our aims. These were, to reduce: • the frequency of appointments/multiple visits• long waiting times • flow of clinic visits from one professional to next.

It was clear that frequent visits were intrusive to work and/or family life, with many women having to arrange childcare to attend clinics, this added to the long waiting time and contributed to a poor healthcare experience for women.

25% reduction in face-to-face appointments for women attending obstetrics clinic (from 4.8 visits per pregnancy to 3.7 visits)

The problem

Our aim

Key achievements

165% reduction in waiting time at outpatient clinic (from 66.2 to 23 minutes)

232.7% reduction in face-to-face appointments for women attending diabetes clinic (from 5.2 visits per pregnancy to 3.5 visits)

Case Study: The Gestational Diabetes Big Room

In one year, 690 hrs saved in waiting time (1040 appointments)

Saving of approximately £474 per pregnancy. Therefore an annual saving of £112,812

10,885 miles saved, equalling 3.1 tonnes of carbon emissions

Thanks to the Flow Coaching methodology we have transformed from a team who felt pressured delivering a service with increasing demands to a successful re-energised team who see opportunities created by adapting our thinking. This has resulted in transformative change to be a more person-centred and eco-aware service while maintaining safe clinical outcomes.Athinyaa Thiraviaraj, Consultant Doctor, FCA Northern Ireland Flow Coach

How did the Big Room achieve these results?

Next steps

Want to know more? Visit the FCA websiteflowcoaching.academy

We created a Big Room with a high level of engagement from service users and stakeholders. Our Flow improvement team was a collaboration between women with GDM and every professional in their care pathway.

We tested possible solutions designed to improve flow of appointments, reducing waiting time (re-design of clinic sequence, appointment slot times) and alternatives to traditional clinic models.

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2 The process and results of the virtual clinic are generalizable to clinical consultations that either have no physical examination or examination/ intervention which can be facilitated by wearable or deployable technology to collect, and transmit healthcare data opening multiple possibilities.

What does this mean for patients?

Virtual clinics supported by cloud-based glucose monitoring technology. We tested acceptability& usability of Bluetooth® glucose monitoring technology with women first. Building on knowledge generated we did incremental tests on video clinics (initially App based progressing to embedded email link) refining the process over four months.

We had a high level of patient and stakeholder involvement particularly through virtual video clinics in which consultations with diabetes specialists (nurse and dietician) were held via the patients’ own smart devices across a secure connection.

On average 40 minutes per patient was saved, meaning less hanging around in the hospital.

Our model is replicable at additional clinics as required. Following our experience, we are poised to spread to pre-gestational diabetes care.

The virtual clinics meant a huge saving on travel and less waiting. It saved some patients journeys of up to 60 miles each way.

With cloud-based glucose monitoring technology, using colour to indicate on-target and out-of-target values, patients became more confident in managing their own care.

1.7 fewer visits per pregnancy episode and 324 hours of drive time saved means less demand on finding childcare or taking time out of work.

There are also other benefits for the medial team which are not as easily measured, such as to our family and work relationships.

Virtual Clinics for GDMCase Study: The Gestational Diabetes Big Room