PATIENT SAFETY
neurosurgery providers reported that when they sought to return patients to the hospital which initially referred them, these referring hospitals, or alternative district general hospitals, frequently responded that they had no capacity. While the cranial neurosurgery provider, as a specialised service, is contractually obliged to accept a referral, there is no comparable duty on the referring hospital to accept the patient back. This issue urgently needs to be addressed.
Urgent care pathway
Patients with some types of brain tumour could avoid long stays in hospital if Trusts adopted an urgent care pathway. Patients with a malignant tumour admitted for emergency surgery as soon as they are referred can lead to many patients waiting several days in hospital before their operation, due to more urgent cases taking priority. Instead, consultant neurosurgeon Nick Phillips, who conducted the review, recommends that Trusts provide an urgent care pathway with elective admission on the scheduled day of surgery within a week of referral. Patients admitted electively rather than via the emergency route benefit from a clear schedule and spend an average of seven days fewer in hospital. The report also highlights University Hospital Southampton’s policy of managing glioma tumour surgery for the majority of patients with the expectation that, wherever possible, patients will stay in hospital for one
The report concludes that there are substantial opportunities to improve patient experience and outcomes, and deliver cost efficiencies of up to £16.4 m.
night only after surgery. This has helped the Trust achieve an average length of stay for elective glioma patients of just two days against the national average of 6.4 days. Mr Phillips identifies a total of 15 recommendations, including: l A streamlined admissions-to-surgery process (admitting more elective patients on the same-day as surgery rather than in advance) helping reduce length of stay. This could save up to 3625 bed days a year, equivalent to a saving of £1.4 m
l Increasing the number of minimally invasive day-surgery procedures such as stereotactic radio surgery, endovascular surgery and trigeminal thermocoagulation, thereby reducing the requirement for overnight admissions and reducing pressure on beds, which could save up to 245 bed days and around £95,000
l Reducing the average length of stay in critical care for cranial trauma patients who undergo surgery to five nights or fewer could save 2030 critical care days at a cost of £1.9 m and free up critical care beds for other patients
l Reserving at least one operating theatre per unit for emergency (non-elective) cases to reduce postponement and cancellation rates for elective procedures could save up to 1,095 spells in hospital per year equivalent to £1 m – and deliver a major improvement in patient experience
l Increasing elective admissions for glioma tumour surgery could save up to £1.18 m based on bed day reductions.
The report concludes that there are substantial opportunities to improve patient experience and outcomes, and deliver cost efficiencies of up to £16.4 m through smarter procurement, avoiding unnecessary admissions and using critical care only when clinically required. Mr Phillips said: “We have been able to pinpoint opportunities for improvement across the entire pathway, beginning with being smarter about when to admit patients: bringing them in on the day of surgery, rather than in advance. I believe that together these recommendations could lead to a substantial increase in capacity – freeing up just one extra bed, per Trust, per day, would allow
SEPTEMBER 2018
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