A 7-day Consultant-delivered non-elective medical service improves clinical outcomes

Michael Robinson1, Tim Noble1, Peter Watson1, Lisa Bromley2, Phil Mettam2, Mike Pinkerton1, Steve Kell2, Sewa Singh1

1. Doncaster & Bassetlaw Hospitals NHS Foundation Trust, 2. Bassetlaw Clinical Commissioning Group

Background

The traditional ‘out-of-hours’ healthcare service model has sub-

optimal amounts of consultant-delivered care and is associated

with a higher mortality for patients admitted at weekends1-3.

In Bassetlaw, commissioners and healthcare providers have

worked in partnership to increase the amount, and reduce the

variation, of consultant-delivered care 7-days a week,

demonstrating the potential of partnership working to deliver 7-

day services and improve clinical outcomes.

Results

Stakeholder feedback and data analysis using Dr Foster Intelligence4

shows:

• Reduced overall and weekend mortality (crude and standardised),

• Shorter average length of stay.

• Improved staff morale, team-working and training.

Table 1: A 12% reduction in standardised mortality and a reduction in average length of

stay of at least 1-day for non-elective medical patients since ATC*.

Graph 1: A 22% reduction in

crude mortality for non-elective

medical patients admitted since

ATC*.

Graph 2: A 25% reduction in

crude mortality for non-elective

medical patients admitted at

weekends since ATC*.

*All figures: red represents pre-ATC, green represents post-ATC

Methods

Primary and secondary care clinicians worked in collaboration

with community and social care providers to redesign the non-

elective medical pathway. Effective clinical leadership, significant

managerial support and a clear patient-centred focus ensured a

sustainable model was funded and implemented.

Initially established in 2011, the Assessment and Treatment

Centre (ATC) uses continuous improvement methods (PDSA) to

deliver consistent high quality care by providing rapid senior

decision-making, early discharge planning, enhanced diagnostic,

therapeutic and social care services, and more senior medical

cover at night 7-days a week.

Significant changes to the infrastructure, clinical workforce and

process of care has enabled substantial progress to be made in

meeting key objectives:

• Initial medical assessment within 1 hour of arrival,

• Treatment decision and care plan within 12 hours of arrival,

• All key diagnostic tests completed within 24 hours of arrival,

• Documented expected date of discharge for all patients.

Conclusions • Bassetlaw hospital’s new Consultant-delivered non-elective medical service has successfully improved the quality of care and reduced hospital

mortality 7-days a week.

• Designing and implementing sustainable 7-day NHS services requires effective partnership working, clinical leadership and managerial support.

• Healthcare organisations need to ensure that the infrastructure, workforce and process of care support the delivery of consistent high quality

patient-centred care.

• Providing NHS services 7-days a week has the potential to reduce variations in care quality and improve clinical outcomes.

References 1. Academy of Medical Royal Colleges. The Benefits of Consultant-delivered care. January 2012. 2. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends compared with weekdays. The New England Journal of Medicine 2001;345:663–8. 3. Keogh B. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report . NHS England July 2013. 4. Dr Foster IntelligenceTM Quality Investigator and Data Analysis Tools.

NHS Services, Seven Days a Week, 16th November 2013, Birmingham

The unique benefits of partnership working