Conserving a scarce resource and improving outcomes Airedale NHS Foundation Trust

The team redesigned the pre-surgical assessment and optimisation process to start at the point when patients were first listed for surgery, rather than weeks later as was routine practice. This allowed waiting times to be used to prepare patients for surgery as well as possible. The new treatment protocols included:

• nurse-led assessment for the majority of patients and quicker access to consultants for patients requiring consultant assessment
• carrying out blood tests at the primary assessment stage, to maximise the time available for optimising the patient's blood count
• scheduling pre-operative assessments according to patient needs
• treating patients requiring intravenous iron immediately with an easy-to-use, low side-effect formulation, rather than booking a separate treatment appointment.

Who was involved

The project was based in the surgical outpatients and pre-operative assessment clinics at Airedale General Hospital and involved surgeons, anaesthetists, haematologists, pharmacists, GPs and the blood transfusion service.

Outcomes

• Blood transfusion rates decreased from 23% to 7% for hip surgery and from 7% to under 1% for knee surgery.
• Length of hospital stay fell by just over one day (hip) and two days (knee).
• Fewer patients were re-admitted within 30 days.
• Colleagues began referring patients waiting for other surgical procedures to the team, for an opinion and management.
• Patient experience improved through having to attend fewer appointments.

Challenges

The team faced questions about the cost-effectiveness of the project and the ‘front-loading’ of drug costs, despite the support of the chief executive. They found this frustrating, as one aim of the project was to establish whether optimisation treatments can generate cost savings.