Factors affecting patient flow in a neurosurgery department

被引:6
|
作者
Irvine, S. [1 ]
Awan, M. [2 ]
Chharawala, F. [2 ]
Bhagawati, D. [2 ]
Lawrance, N. [3 ]
Peck, G. [4 ]
Peterson, D. [2 ]
Banerjee, S. [5 ]
Camp, S. [2 ]
机构
[1] Univ Hosp North Durham, Durham, England
[2] Imperial Coll Healthcare NHS Trust, Charing Cross Hosp, Neurosurg Dept, London, England
[3] Imperial Coll Healthcare NHS Trust, Improvement Team, London, England
[4] Imperial Coll Healthcare NHS Trust, St Marys Hosp, Major Trauma Ctr, London, England
[5] Imperial Coll Healthcare NHS Trust, Charing Cross Hosp, Stroke Med, London, England
关键词
Length of stay; Cost; Frailty; Bed occupation; Neurosurgery; IMPACT; CARE;
D O I
10.1308/rcsann.2019.0090
中图分类号
R61 [外科手术学];
学科分类号
摘要
INTRODUCTION Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow. MATERIALS AND METHODS All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses. RESULTS A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; P <0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; P <0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over 1 pound million per year. CONCLUSIONS SAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network and identified a role for a geriatric liaison service.
引用
收藏
页码:18 / 24
页数:7
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