Blackpool Teaching Hospital NHS Foundation Trust commissioned Midlands and Lancashire Commissioning Support Unit to lead a two-year project (2019 – 2021) focusing on a number of work streams, with each having a defined objective towards the ‘reduction of occupied bed days’. Regular board level governance incorporated both the trust and the Fylde Coast Clinical Commissioning Groups.
Action
A comprehensive deep dive of local evidence by our analytics experts helped create a suite of quality indicators that demonstrated areas of improvement and was therefore key to the success of the overall Bed Reduction Programme. The support of 600 consultant days was agreed across a 2-year time frame, with an emphasis placed on a number of supplementary outcomes that were associated with the overall objective (see outcomes). Specific key areas of intervention and support around pathways and the full utilisation of existing resources were included in a detailed project plan which formed the basis of regular reports to gauge progress into the project board.
Each workstream was allocated a MLCSU clinical subject matter expert and a defined team structure that replicated triumvirate working from the appropriate areas of nursing and operational leadership teams from both the trust and the CCGs. Programme support, monitoring and leadership for each work stream was then led by the CSU.
Intervention and support was given both on site and remotely, with a firm emphasis placed on long term cultural change and future workforce capability within the trust to ensure strategic progress was monitored and permanent change was delivered.
Impact
Expected outcomes:
* Increase in zero-day length of stay (same day emergency care) rate from 23% to 33% (in line with the regional average)
* Increase direct admission rate from current 26.1% to 32.02% (in line with regional average)
* Targeted 15% reduction in occupied bed days* per 1000 population in 65 +age group
The outcomes to date:
* An increase in the zero-day rate to ~30% at the end of December 19
* A ‘direct admission rate’ (patients admitted via any route other than the A&E) of 33% as at November 19 and subsequently ensured direct admission rates were at 32.02% for three consecutive months
* Approximately 22 beds per day (net) have been released. The increase is largely amongst Blackpool CCG residents (Blackpool increase = 40 beds per day; Fylde and Wyre increase = 18 beds per day)
Nb: Average length of stay reductions seen for 27% of all Frailty inpatient service users (pre-Covid) and the new Frailty Assessment service was proven through a test of change phase (March 2020).
Direct admission to assessment wards, effectively by-passing A&E, allows for effective handling of patients within wards, and also generates capacity in the A&E bays.