Dr Foster Intelligence | Case studies

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As a specialist paediatric centre we are at the forefront in many areas, but there are others where we would not expect to be close to the national average because our clinicians would never consider doing a child's cataract or hernia as a day case.

Alastair Leinster Head of Information

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Hospital funding is now based on payment for the number of services provided, so it is in the hospital's interest to maximise efficiency.

When the Trust compared its day-case rate with other children's hospitals and national averages, it compared well. "As a specialist paediatric centre we are at the forefront in many areas, but there are others where we would not expect to be close to the national average due to the inherent differences between paediatric and adult practice; for example, the repair of a child's cataract or hernia are not comparable to the same operations on adults," says Alistair Leinster, head of information.

However, when its clinicians looked at tonsillectomies, they started to ask questions.

[more info] Day case rate for tonsillectomy. This CUSUM chart is looking at positive outcomes, showing that since 2005 the day case rate is consistently better than the national average.

Solution

Clinicians at the Royal Liverpool Children's NHS Trust investigated the data and discovered that hospitals with a 100 per cent day case record for tonsil removal had worse outcomes than their own. "More children were readmitted as an emergency with bleeding," Leinster explains, "but when we looked at hospitals performing 80 per cent of tonsillectomies as day cases we found they had better outcomes than our peers."

Outcome

Efficiency has greatly improved because the Royal Liverpool Children's NHS Trust now treats all appropriate tonsillectomies as day cases.

Tool

Real Time Monitoring