Sustainable use and reuse of Augmentative and Alternative Communication devices in Great Ormond Street Hospital

Project completed as part of the Great Ormond Street Hospital Green Team Competition.

Team members: Phillippa Mackenzie and Yasmin Dolin, Speech and Language Therapists

Setting / patent group: Children and young people requiring tertiary assessment and intervention through the GOSH Augmentative Communication Service (ACS).

Issue:

GOSH ACS observed a significant number of AAC users not utilizing their communication devices effectively, leading to suboptimal patient outcomes and contributing to financial and environmental waste. We realised through process mapping there was little within the current process to encourage patients to return unused or broken devices. The aim of this project was to assess process changes that could enhance patient outcomes while addressing social, economic, and environmental aspects.

Interventions

1) improve device return rate for un-used devices

2) extend lifespan of long-term devices,

3) reduce courier journeys to GOSH for device repairs

4) donate devices to local SLT services when they are no longer suitable for patients or GOSH team.

We made the following changes:

• Providing information to families to encourage early identification of problems with device usage at device handover including information on the environmental benefit of returning devices if they are not of benefit to them, and troubleshooting support.
• Emailing families and locals services six weeks after device issue, reminding families to contact us with any problems.
• Patient progress monitoring (PPM) moved from 24 months to 12 months: this is designed to increase return rate for unused devices as well as identifying problems earlier thus improving patient outcomes. This aim will be initiated during this project but will take at least 12 months to achieve
• Extending lifespan of long-term devices for service users (new and returned devices). Previously devices would not be re-issued to patients if they were older than 2 years, unless for a user with a history of breaking devices. Criteria was created for ensuring an equitable way of weighing up sustainability goals with patient outcomes considering how old the device is, how often it was used prior to being returned and how much it would cost to repair it (if applicable), then comparing it to the child’s needs and their history of requiring repair/ replacement
• Donating suitable devices to local services when no longer suitable for service users or required by team. We have planned an information morning for local SLTs in February 2024. We intend to donate several devices to local SLT services during this morning.

Outcomes

The team require 6-12 months to collect data. Projected predicted annual savings are detailed below.

Clinical: Patients no longer using their device will be identified and can be re-assessed for a more suitable device sooner - improving patient communication both at home and school - benefiting wellbeing and education attainment.

£6,073 (£5,600 from repurposing 4 additional devices/software and £473.10 by by reducing repairs by 1 device per fortnight.

772 kgC2e, equivalent to driving 2,280 miles in an average car (483 kgCO2e from repurposing 4 additional devices/software and 289.4 kgCO2e by reducing repairs by 1 device per fortnight.

Social: Local SLTs, teachers and parents empowered to troubleshoot simple issues, preventing delays in children accessing their device while they wait for support. Reduced troubleshooting calls to our service saving staff time Donating old devices to local SLTs (rather than back to manufacturers) provides local teams with resources they would not otherwise have access to. These can be used for their own training, as well as patient trials. This may support local SLT confidence and job-satisfaction.

Key learning point

This project has allowed us to recognise that by making some simple and achievable changes to our current device loaning process, we can improve patient outcomes while increasing our environmental sustainability, economic sustainability and social sustainability targets.