It’s safe to say that Dean Street Express does not look like your typical NHS clinic. It’s frontage in the heart of London’s Soho resembles one of the many ad and PR agencies that are based in the area, while its reception and waiting areas also draw inspiration from smart offices.
It is the automation and speed of the service offered by the clinic that really set it apart, however. Chelsea and Westminster Hospital NHS Foundation Trust, which runs the service, worked with its suppliers, Blithe Computer Systems and Cepheid, to make the process fully automated.
Users check-in using touch screen kiosks, pick up a testing kit if appropriate, take a swab with the help of video instructions, have it processed on site, and then receive their results by SMS within hours and sometimes minutes.
As Jake Jenkins, a nurse practitioner in LGBT services for the trust, told EHI Live 2014, the speed is important; not just because it delivers a better service for users, but because some of those users have many sexual partners. Diagnosing infections in people who have no symptoms should stop their spread around the local community.
From 56 to 34
Jenkins told the show that Dean Street Express grew out of another innovative sexual health service, 56 Dean Street. This has some of the same vibe, but offers appointments with medical staff and a full, outpatient HIV clinic service.
“56 Dean Street has been open for six years,” Jenkins explained. “It is a huge building but, alas, the more capacity we have, the more we fill. We had lots of appointments when we first opened, but as time went on it got more difficult to get an appointment.
“We realised we needed to change, so we decided to open Dean Street Express as a clinic that lets people without symptoms just walk in and get results fast.”
Ian Shell-Macleod, a senior development analyst at Blithe Computer Systems, said the trust approached it because it was already using its sexual health clinic management system, Lilie.
“We have a well-developed product, and what they wanted to do was to integrate it with other systems to make the whole process as automated as possible.”
For example, the awards judges heard, Blithe went to Germany to find suitable touch-screen kiosks. These not only enable people to check-in automatically, but to enter a basic medical history. This determines the test they need, and enables the system to print out a bar-coded, printed label for swabs (blood tests are still taken by staff).
The swabs are sent by vacuum tube to the GeneXpress testing lab – “my favourite bit,” Shell-Macleod told Live – from where they are entered back into Lilie. The system then generates an SMS for the user, usually within six hours (HIV tests are given in 60 seconds).
More people, faster turn-around
Jenkins said the main result of all this was far greater efficiency. Dean Street Express saw around 100 patients per day in the first month that it opened, but is now seeing around 300; of which around 10% receive a positive result.
The average amount of time spent in the clinic is 30 minutes, in comparison to two hours in the non-express clinic, and the average taken to receive a result is three to four hours, in comparison to 169 hours in the non-express clinic.
The time that it takes to get people into treatment has also improved massively. Jenkins said the average time to treatment after an attendance was 47.9 hours, in comparison to 267 hours in the non-express clinic. However: “On the day we opened, somebody came in at midday, and started treatment at 4pm.”
In addition, patient feedback has been very positive; and staff have taken to the new way of working. “Before we opened, some staff did worry that it might be very impersonal,” Jenkins admitted in response to a question at Live. “But now staff really like it.
“You get a lot of [medical history] information when the patient comes into see you, so you don’t have to ask them questions they might be embarrassed to answer. You can spend time giving people advice and dealing with their problems, instead of telling one person after another that they have a negative result.
“It has actually taken the focus off the software, and ordering tests, and getting the results up on the computer. You can focus on the person in front of you.”
Build and still they come
Shell-Macleod pointed out that all the work Blithe has done with Dean Street Express is now “baked into Lilie” – so other sexual health services can pick up and run with similar ideas; even if they don’t want to make the type of investment that Chelsea and Westminster made in the onsite lab.
“One of the criteria for the award was whether this could be used elsewhere, and this is can be used by people around the country,” he said.
Unfortunately, the one thing the clinic has not done is to reduce demand on 56 Dean Street. “Demand hasn’t reduced, although it has shifted,” Jenkins said.
“The asymptomatic population has come over to Dean Street Express, and we do hope to free up a floor at 56 Dean Street to deliver HIV treatment. Unfortunately, though, as we create capacity we find ourselves using it.”