Irvine S, Awan M, Chharawala F, Bhagawati D, Lawrance N, Peck G, Peterson D, Banerjee S, Camp S
University Hospital North Durham, Durham, UK.
Neurosurgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Ann R Coll Surg Engl. 2020 Jan;102(1):18-24. doi: 10.1308/rcsann.2019.0090. Epub 2019 Jun 24.
Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow.
All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses.
A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; < 0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; < 0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over £1 million per year.
SAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network and identified a role for a geriatric liaison service.
患者流程是实现患者流动和临床工作效率的过程。本研究的目的是实施和评估英国国民保健制度改进局（NHS Improvement）的SAFER患者流程包，评估“红转绿”倡议的影响，并评估虚弱对患者流程的影响。
纳入2017年9月1日至11月30日入住神经外科病房的所有患者。根据英国国民保健制度制定的指南，前瞻性地从每日病房名单和患者病历中收集数据，包括人口统计学信息、入院和出院细节、住院时间、预期出院日期、有原因的红色日期以及虚弱程度（Rockwood临床虚弱量表）。使用英国国民保健制度参考成本进行成本分析。
共纳入420例患者（55%为择期手术患者），总计3909个床日。所有患者均在中午前接受每日高级评估，预期出院日期在每日多学科团队会议上确定。10%的患者在中午前出院。有21%（837个）红色日期，急诊患者的红色日期显著更多（76%，639个对198个择期手术患者；<0.001）；63%的红色日期归因于等待当地医院的床位；25%（10ó）的患者被归类为虚弱（50例择期手术患者），这与显著更长的住院时间相关（17.3天对6天；<0.01），以及更多的红色日期（615个对222个；p<0.01）。考虑到额外的床位费用和收入损失（含罚款），红色日期每年造成的成本超过100万英镑。
SAFER已确定患者流程中需要改进的领域，具有明显的成本影响。它为转诊网络内的讨论创造了一个平台，并确定了老年联络服务的作用。
