Dr Foster Intelligence
Dr Foster Holdings LLP
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This is not just about cost saving, it's about improving patient care. It's an absolute win-win situation and having good quality information enables this.
Gareth Goodier former Chief Executive, North West London SHA
A "win-win" situation
Before its reorganisation, North West London Strategic Health Authority used Dr Foster Intelligence information systems to investigate how it could reduce lengths of stay after identifying that trusts in its area had lengths of stay in excess of 40 days. London's acute Trusts continue to use these systems.
Solution
Gareth Goodier, former chief executive of North West London SHA, says,
"Many of our acute Trusts were shown to be quite inefficient, in having very long lengths of stay, when clearly national and international benchmarks showed that they could do it a lot more effectively and efficiently.
"When we analysed the information from Dr Foster, we found that some acute Trusts had lengths of stay up to 36 days, as an average. As we drilled down, we found that short lengths of stay were associated with better clinical outcomes for patients. In some cases, long stays meant delays in accessing investigations and, at worst, in some instances this seemed to lead to an increased mortality.
"There were some processes and system issues, in terms of getting the patient to go through the clinical pathway. One example is the treatment of fractured neck of femur. We found that to look after a patient well, you needed to get through the A&E process within an hour or two, do the surgery within 24 hours, mobilise the patient within 48 hours, and you count the number of patients who go home in four days."
Ralph Elias, turnaround advisor, says, "We spent six months working with the different Trusts around data. We looked at the patient pathways and made every Trust come up with a detailed action plan."
Outcome
Lengths of stay for patients with a fractured neck of femur were reduced by 30 per cent. At the start of the project, some hospitals had lengths of stay of more than 40 days. By the end, every hospital had an average stay of less than a month.
All 15 London Trusts currently in turnaround have a target of reducing lengths of stay by 25 per cent. All the former North West London Strategic Health Authority Trusts are using at least one of Dr Foster Intelligence's benchmarking systems to achieve better results.
"In six months, one trust had reduced its average length of stay from 36 days to 18," says Gareth Goodier, former chief executive of North West London SHA. "It just shows that with a little bit of focus and attention, you can dramatically improve the length of stay and save thousands of pounds. Our belief is that in many of these cases you also improve patient care because what tends to happen [with longer stays] is that patients go through A&E slowly, sit around on the ward for a few days before they have the surgery, haematoma collects around the wound, the surgery is more difficult, complications are more likely, infection is more likely and so on.
"This is not just about cost-saving; it's also about improving patient care. It's an absolute win-win situation. The hospital saves money which can be reinvested in other patient care, the patient has a better outcome, gets home earlier and is safer, fitter and better. And having good-quality information enables this.
"This is a management tool. I often refer to it as having a series of radar screens and you're looking for blips. When you get the blips, you engage with your clinicians, your doctors and nurses and other staff and examine the blips to see why you've got them. Sometimes the blips are quite reasonable; sometimes there is a difference in the complexity of the case. But if you don't have the radar screen and you don't look at the blips, you'll never really discover anything," Goodier adds.
Tool
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