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Improving wait time from referral to opiate replacement therapy in a drug recovery service
  1. Michelle Beattie1,
  2. Gavin Hookway2,
  3. Michael Perera3,
  4. Suzy Calder4,
  5. Carolyn Hunter-Rowe5,
  6. Hugo van Woerden6,7
  1. 1 Department of Nursing, University of the Highlands and Islands, Inverness, Scotland
  2. 2 Kaizen Promotion Office (KPO), NHS Highland, Inverness, Scotland
  3. 3 Mental Health, LD and Drug and Alcohol Recovery Services, NHS Highland, Inverness, Scotland
  4. 4 Drug and Alcohol Recovery Services, NHS Highland, Inverness, Scotland
  5. 5 Highland Alcohol and Drugs Partnership, NHS Highland, Inverness, Scotland
  6. 6 Public Health Department, NHS Highland, Inverness, Scotland
  7. 7 School of Health, University of the Highlands and Islands, Inverness, Scotland
  1. Correspondence to Dr Michelle Beattie; michelle.beattie{at}


While the reported incidence of heroin use in the UK has reduced, related hospital admissions and associated mortality have continued to increase. Prompt access to treatment (opiate replacement therapy (ORT) and counselling support) have been shown to reduce risk and offer clients the optimal route to recovery. The Specialist Drug and Alcohol Recovery Service (Osprey House) within National Health Service Highland had lengthy delays from referral to commencing ORT (median wait 56 days), which this project aimed to reduce.

A rapid process improvement workshop (RPIW) was undertaken to redesign the patient pathway from referral to recovery. The RPIW consisted of three phases: phase I, planning and preparation (12 weeks before the workshop week); phase II, the workshop week; and phase III, the follow-up. Metrics included the lead time from referral to initiating ORT and other process measures at baseline, and then repeated at 30, 60, 90 and 180 days, respectively. Additionally, data were routinely collected on the percentage of clients treated within 3 weeks, as was weekly data on the new process of screening clients within 1 day of referral. Multiple lean tools and techniques, including Plan, Do, Study, Act cycles, were used to test and implement new ways of working.

Results at 180 days found the median time from referral to initiating ORT improved from a baseline of 56 to 21 days (63% improvement), room usage improved from 49% to 65% (32% increase) and standard work improved from level 1 to level 3. Increases in the number of clients treated within 3 weeks were demonstrated. Other metrics remained static or reported fluctuations too inconsistent to claim improvement at this point.

By applying the Lean principles of removing waste and increasing value, we have redesigned our service, reducing the length of time clients with drug problems wait from referral to commencing ORT.

  • lean management
  • patient-centred care
  • continuous quality improvement
  • mental health
  • healthcare quality improvement

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  • Contributors MB, GH, MP, SC and HVW designed the RPIW. GH coached MP and MB through all stages of the RPIW. SC was the process owner responsible for implementation of the improvement. MB and MP conducted data collection, observations and analysis. HVW provided strategic direction and oversight for the RPIW. CH-R provided data advice and run charts. MB drafted the paper and all authors revised before agreeing the final version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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