Metabolic Bone Treatment Service Overhaul: A Quality Improvement Approach
Abstract
Introduction
The Assessment and Rehabilitation Day Unit (ARDU) at Aintree Hospital is responsible for the safe and timely administration of treatments for osteoporosis. In the last 5 years patient numbers have increased significantly, leading to an overwhelmed service resulting in long overdue waiting lists and a burnt-out team. A Quality Improvement (QI) project was initiated to stabilise the service and reduce the overdue waiting list by 50% by October 2025.
Method
Using a clinical microsystem approach, the team developed a driver diagram and measurement strategy to identify priority areas, including clinic efficiency, pre-appointment optimisation and staffing resilience.
Interventions were co-designed with ARDU team members and tested using PDSA cycles. Key tests included standardising blood sets and letters; introducing “admin-as-you-go”; segmenting waiting lists and optimising pre-appointment blood tests.
Process data were collected through time-motion observations, interruption counts, bloods workflow mapping and waiting list analysis.
Results
The service achieved a 54% reduction in overdue appointments, with the overdue list going from 276 patints at initiation to 125 by October 2025.
Standardisation of blood tests coupled with utilisation of the drive-through phlebotomy service led to a reduction in delays. 33% of patients completing phlebotomy outside of ARDU, reducing the number interruptions. Patient feedback has been positive.
After the implementation of admin-as-you go, time-motion analysis showed an average of 47 minutes between the final patient and clinic close, highlighting opportunities for workflow redesign.
Improved prescription preparation and waiting list segmentation has reduced administrative burden. The ARDU team reports improved workload stability and clearer role delineation, and morale has improved.
Conclusion
A structured QI approach enabled meaningful, measurable improvements in clinic flow, demand management and staff experience. The reduction in overdue appointments indicates emerging system stability, creating capacity for next-phase improvements such as expanding group treatment sessions, applying QI methodology to the metabolic bone disorders clinic and preparing for further expansion of the treatment clinic with the upcoming initiation of Fracture Liaison Service. Embedding standardised processes and role optimisation support long-term sustainability, team resilience and improved patient experience.