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Challenges in reducing TIA clinic waiting times from 9 to 3 days in an acute Welsh hospital
  1. Manju Krishnan1,
  2. Andrew Jones2,
  3. Tal Anjum3,
  4. Srikanth Chenna3,
  5. Peter Michael Edward Slade3,
  6. Karen Ward3,
  7. Sarah Yeap3
  1. 1 Department of Stroke Medicine, Morriston Hospital, Abertawe Bro Morgannwg University health Board, Swansea, Wales, UK
  2. 2 Information, Development & Infrastructure, Abertawe Bro Morgannwg University Health Board, Baglan, Wales, UK
  3. 3 Stroke Medicine Morriston, Morriston Hospital, Swansea, UK
  1. Correspondence to Dr Manju Krishnan, Department of Stroke Medicine, Morriston Hospital; Manju.Krishnan{at}


A patient impact project which successfully reduced the transient ischaemic attack (TIA) clinic waiting time from 9 to 3 days in an acute Welsh hospital, revealing the challenges faced and how alternative thinking and team work improved care given to our service users. Evaluating current situation, careful planning with multiple brainstorming meetings, 4 N chart and driver diagram with change ideas laid the foundation for this service improvement. Run charts, statistical process control and Pareto charts helped to identify the issues that are hindering the progress, which when rectified, reduced the clinic waiting times. Avoiding clinic cancellations by cross covering TIA clinics with mutual agreement among consultants and redeployment of ward staff to support clinics resulted in a positive impact to the patients. The average waiting time to see a patient in TIA clinic dropped from 9 days to just 3 days as a result of this, reflecting the hard-working and proactive nature of a team following a collaborative leadership journey. The service improvement initiative for ‘avoiding clinic cancellations’ was implemented in January 2017 and has reduced our waiting times by three times. Repeat analysis by six monthly Plan Do Study Act cycles revealed that this improvement is sustained.

  • teamwork
  • quality improvement methodologies
  • patient-centred care
  • healthcare quality improvement

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  • Contributors MK: planned and led the project. AJ: assessed database and helped with charts. TA, SC, PMES: contributed in brainstorming meetings and implementation of change ideas. KW: managed the stroke clinical nurse specialist role in clinic. SY: envisioned the extended band 3 role in clinic and provided training for the same.

  • Funding The Quality Improvement project was undertaken as part of medical leadership programme organised by AcademiWales, which aims to harness the talents of leaders in public services across Wales. ABMU health board fully sponsored the leadership learnings. The service improvement project did not need any additional funding, but we were able to acquire a new clinic space once the project was successful. This required a small funding to refurbish the clinic area, giving us the opportunity to increase our clinic activity to match the demand.

  • Competing interests None declared.

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

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