The University Hospitals of Leicester

A study made in Leicester in February 2007 . I'll write more about this when I've a chat with Veijo Lesonen. Details to be found in powerpoint presentation. Download ppt.

Delivering the 18 week Patient Pathway

• 17th July 2007 by Malcolm Clarke
• Can it be done?
• By whom?
• When?
• How?

The Leicester Experience

• Overview Leicester Carpal Tunnel Service
• Traditional ways of working
• The Leicester Experience
• Traditional NCS in U.K.
• New Method of NCS
• Anglo-Finnish Collaboration
• Results /Audit
• Nurse Operating

Overview Leicester C.T.Service

• Nurse Led service
• 850 Operations per year
• 1100 New patients
• 1200 Follow-ups
• Average back to work post op 4 Days
• 12wks from referral to discharge

Traditional Ways of working

• Totally Ineffective
• Costly (wasteful Tax payers Money)
• Overkill on Resource (Theatre, Day Bed)
• Overuse of Manpower (Doctors, Nurses,Admin)
• Not Patient Friendly (Intimidating not Natural)
• Time Consuming ( Too Many Handoffs)

The Leicester Experience

• Highly Effective
• Value for Money (No Bed, No Theatre)
• Minimum Resource (Treatment Room )
• Small Manpower Resource (3People)start to finish
• Extremely Patient Friendly (Non Threatening)
• Time Effective ( Fast, Efficient Patient Pathway)

Savings to be Made being Effective

• No Bed £250 per half day
• Theatre £400 per half hour
• N.C.S £160 per Test

Traditional N.C.S. U.K.

• 16-20 Week Wait and can be much longer
• Cost between £120-£400 per test
• Referral to different hospital
• Not nice test for patient
• Long Referral to Discharge
• Totally Unacceptable

Anglo-Finnish Collaboration

• Leicester-Oulu
• 65 Patients
• All Traditional and Mediracer Tests
• 61 Operations for CTD
• 6mth Follow-up Mediracer (Sept 2006)

Results submitted for Publication

• Results/Audit Nurse Operating
• 3500 Operations
• 6000 New Referrals
• 8000 Follow-ups
• 97.8% Success Rate
• 2% Complication Rate
• High Patient and GP satisfaction rate

New Method of NCS

• No Wait (Test at 1st Appointment)
• Costs about £25-£30 for disposables
• No Referral to other Hospital required
• Comfortable for patient
• Results at 1st Appointment
• Treatment Discussed

Outcome

• Completion of Whole Treatment inside the 18 week timeframe.
• Guaranteed For all Patients
• Happy Patients/Relatives/Clinicians
• Shorter Waiting Lists
• Quality deliverance of care
• Hospitals able to tick the box
• Government achieve projected goals and claims

Early return to work

• £76.40 per day CBI Figures
• Sick pay, Lost Productivity,Loss of Tax
• 100 patients/ 75 working age
• 6 weeks off work/ 2 weeks off work
• £240,660 / £80,220
• 42,000 Ctd per year = Savings
• £67,384,800.00 one condition
• Smarter Thinking + Early return to work
• = Savings of £91,114,800.00 Minimum for the condition of Carpal Tunnels alone

The Future

• Patients treated in a one-stop Pathway
• No limit on patients treated
• No making patients wait 18 weeks
• Money saved invested back into services
• Safe guarding the NHS

Summary

• Clinically Led -Patient focussed services
• Nurse Led/Others from referral to discharge
• Large input on patient Comfort/Satisfaction
• Do use Cost Effective methods for Tests and Surgery
• Do not use theatres ( Usually £800 per hour)
• Do not use beds ( Usually £250 per half Day)
• Early Return to Work+Change of Practice could save a minimum of £100 Million