Improving quality in a national intestinal failure unit: greater efficiency, improved access and reduced mortality.

PROBLEM

In 2010, there was a significant waiting list for admission to the intestinal failure unit (IFU) at the Salford Royal National Health Service (NHS) Foundation Trust. There had been a steady increase in the number of new patients referred to the IFU (89 patients 2005; 152 patients 2012) and the number of established patients requiring home parenteral nutrition (HPN) (135 patients 2005; 206 patients 2012) over the last decade. The impact of the resulting long waiting list for these complex patients was that patient deaths occurred in those awaiting admission.

DESIGN

Continuous improvement methodology using the model for improvement and sequential plan-do-study-act cycles.

SETTING

Salford Royal NHS Foundation Trust IFU; a large NHS teaching hospital in Northwest England.

KEY MEASURES FOR IMPROVEMENT

The primary outcome measures were inpatient length of stay and time spent on waiting list prior to admission.

STRATEGIES FOR CHANGE

A continuous improvement programme, supported by a project manager.

RESULTS

There has been a 21% reduction in average length of stay on the IFU from 55.7 to 44.0 days and a reduction of 72% in the average length of time new patients spent on the waiting list for admission from 65.7 to 18.5 days. These changes were associated with concomitant reduction in 30-day readmission rate from 12.1% to 4.5% and early suggestions of reduced inpatient and waiting list mortality.

CONCLUSIONS

It is possible to improve the efficiency of a large national service for complex patients using quality improvement methodology, resulting in improved access and reduced waiting list mortality.