Listeriosis probe identifies multiple deficiencies

Abstract

<h3>Problem</h3> 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. <h3>Design</h3> Continuous improvement methodology using the model for improvement and sequential plan–do–study–act cycles. <h3>Setting</h3> Salford Royal NHS Foundation Trust IFU; a large NHS teaching hospital in Northwest England. <h3>Key measures for improvement</h3> The primary outcome measures were inpatient length of stay and time spent on waiting list prior to admission. <h3>Strategies for change</h3> A continuous improvement programme, supported by a project manager. <h3>Results</h3> 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. <h3>Conclusions</h3> 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.