Dr Foster Intelligence

Efficiency

Problem: The trust identified a large increase in emergency admissions and, as part of the solution, wanted to support staff in improving information use across the organisation.
Solution: An incentive scheme was introduced to help bring down the emergency admissions as quickly as possible while encouraging teamwork and communication between GPs and trust staff.
Outcome: Patient pathways are more clearly understood, and less time is needed to identify areas of improvement, leaving more time to design solutions.
Tool: Patient and Provider Monitor.

Problem: The trust wanted to drive service improvement cohesively by bringing together different departments and incorporating patient feedback.
Solution: PPM is used to compare trust performance with peers. Information such as on length of stay and bed numbers is also examined at directorate level, helping to drive improvements.
Outcome: Length of stay has been reduced in three key areas: hip, knee and cardiac care. The Trust was able to save more than 9,000 bed days, a ward’s worth of bed days, in one year.
Tool: Practice and Provider Monitor.

Problem: The Trust wanted to streamline the committee structure, improve reporting to the board and give a greater focus to the clinical directorates' involvement in innovation and achievement.
Solution: Committee structures were reviewed with the goal of more efficiently achieving business objectives, and a clinical scorecard programme was piloted in the Cardiac Sciences department.
Outcome: Governance committees were strengthened, and better analysis and reporting are increasing the effectiveness and efficiency of the Trust.
Tool: The Intelligent Board report, Real Time Monitoring, Practice and Provider Monitor

Problem: The trust was unsure about the quality of its clinical cardiac data and the accuracy of its coding.
Solution: Professor Bruce Keogh was commissioned to produce a report for the trust, detailing ways to improve working practices and data collection. Within nine months, the trust successfully implemented all 13 recommendations given in the report.
Outcome: There was a great improvement in the quality and safety of service provision and care pathways across cardiac departments. The trust is now able to show that is has one of the highest survival rates in the country for the treatment of acute heart attacks.
Tool or service: Practice and Provider Monitor and Real Time Monitoring

Problem: Dr Foster Intelligence's data was telling hospital managers that their lengths of stay were longer than the national average
Solution: Managers took the data to clinicians for analysis. By engaging them with their data and giving them ownership, managers were able to collaborate with clinicians in solving the problem. Together they found that the length of stay was skewed because of the hospital's in-house rehabilitation unit.
Outcome: Working together to understand the data increased the amount of positive teamwork and information sharing across the organisation. Cross-discipline engagement has been increased and coding tightened, resulting in a better overall understanding of the different aspects of running a successful hospital.
Tool: Practice and Provider Monitor and Real Time Monitoring

Problem: Length of stay on medical wards
Solution: After examining its monthly length of stay data, the Trust found that ten per cent of its patients were occupying 50 per cent of its beds. A team was formed to target patients staying 28 days or more, the majority of whom were elderly and needed rehabilitation and community support. Changes included revamped discharge procedures that lowered stays to below the two-week national average.
Outcome: The Trust saved £1million in 2005.
Tool: Real Time Monitoring

Problem: Length of stay for fractured neck of femur
Solution: The Strategic Health Authority identified some hospitals that had a length of stay in excess of 40 days. It carried out a pilot programme in acute Trusts doing hip replacements that achieved a 30 per cent reduction in length of stay. It then spent six months working with each Trust on its data to investigate patient pathways.
Outcome: The average length of stay at all the Trust's hospitals was reduced from 40 to 28 days.
Tool: Real Time Monitoring and Practice and Provider Monitor

Problem: Pre-operative length of stay and low day-case rate
Solution: The hospital looked at the way general acute hospitals carried out tonsillectomies on children. The Royal Liverpool performed only five per cent as day cases, but it realised that some hospitals performed up to 80 per cent as day cases and achieved better outcomes. Now all appropriate children's cases have tonsillectomies carried out as day cases.
Outcome: There has been a large increase in day cases for certain procedures.
Tool: Real Time Monitoring