Hospital Dr News

New recommendations after specialist surgery performance dips due to bed shortages

Just one third of providers for a specialist surgery are meeting waiting times standards, a new report shows.

A report into cranial neurosurgery showed bed shortages had seen only eight of England’s 24 providers hitting the elective waiting time target, with another third with a performance of less than 60%.

The latest report from the Getting It Right First Time programme (GIRFT) found surgical teams were frustrated by the high number of delays and subsequent cancellations in the specialty.

Around 75,000 patients receive neurosurgery on the NHS each year. Some are emergencies such as traumatic brain injuries and blood clot on the brain. Other procedures, such as surgical removal of a malignant tumour, can be conducted urgently within a few days of diagnosis; while others such as treatments for chronic pain due to trigeminal neuralgia can be planned as elective procedures.

Common issues included problems with admissions before the day of surgery and significant delays in discharging patients, often because district general hospitals would not accept transfers once a patient had been treated.

This can mean patients who need urgent treatment miss the two-day target.

The report from GIRFT said patients with some types of brain tumour could avoid long stays in hospital if trusts adopted an urgent care pathway.

Consultant neurosurgeon Mr Nick Phillips, who conducted the review, recommends trusts provide an urgent care pathway with elective admission on the scheduled day of surgery within a week of referral.

Patients admitted electively rather than via the emergency route benefit from a clear schedule and spend an average of seven days fewer in hospital.

The report also highlights University Hospital Southampton’s policy of managing glioma tumour surgery for the majority of patients with the expectation that, wherever possible, patients will stay in hospital for one night only after surgery.

This has helped the trust achieve an average length of stay for elective glioma patients of just two days against the national average of 6.4 days.

There are substantial opportunities to improve patient experience and outcomes, the review says, and deliver cost efficiencies of up to £16.4m through smarter procurement, avoiding unnecessary admissions and using critical care only when clinically required.

These opportunities include:

  • Increasing the number of minimally invasive day-surgery procedures such as stereotactic radio surgery, endovascular surgery and trigeminal thermocoagulation, thereby reducing the requirement for overnight admissions and reducing pressure on beds, which could save up to 245 bed days and around £95,000.
  • Reducing the average length of stay in critical care for cranial trauma patients who undergo surgery to five nights or fewer could save 2,030 critical care days at a cost of £1.9m and free up critical care beds for other patients.
  • Reserving at least one operating theatre per unit for emergency (non-elective) cases to reduce postponement and cancellation rates for elective procedures could save up to 1,095 spells in hospital per year equivalent to £1m – and deliver a major improvement in patient experience.

Mr Phillips said: “We have been able to pinpoint opportunities for improvement across the entire pathway, beginning with being smarter about when to admit patients: bringing them in on the day of surgery, rather than in advance.

“I believe that together these recommendations could lead to a substantial increase in capacity – freeing up just one extra bed, per trust, per day, would allow thousands more patients to receive the care of cranial neurosurgeons.”

The GIRFT recommendations will be taken forward with NHS Improvement and relevant bodies.

Bookmark and Share

Post a Comment

Enter this security code

Submit Comment for Moderation