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ith the successful introduction in 2013
of the Model of Care for Acute Surgery,
following on the earlier implementation
of the Elective Model, it is now timely
to take stock of what has been achieved
by the National Programme in Surgery
and the challenges that still remain to ensure that the Programme
fulfills its promise of a transformed model of patient care.
Professor Frank Keane and Mr Ken Mealy, Joint Leads of the
National Programme in Surgery (NPS) spoke to Surgical Scope
about progress to date and warn of pitfalls to be avoided.
The NPS has been met with general acceptance and a genuine
commitment to its underlying principles, according to Mr Mealy.
"There is now a practical consensus established on the Models of Care
for acute and elective surgery, including the separation of streams and
activities of acute and elective surgery. Surgical governance structures
have been put in place and implementation of the Models is well
underway in hospitals across the country. As a consequence, we are
seeing increases in surgical activity and productivity."
Crucially, Mr Mealy says, these positive impacts can only be rendered
meaningful for patients and practitioners if they are measured, as
extensively and objectively as resources allow.
To demonstrate the impact that the NPS is having to date, it is
worthwhile looking at key statistics from 2010 and 2012 (CompStat,
HIPE Analysis and NQAIS). Comparing the figures shows that, in
surgical volume is up 9.6 per cent;
bed day usage is down by 7.2 per cent; and,
day case rates are up 8.7 per cent.
There has been a saving of 191,006 `true' bed days, which equates to
net savings worth 16m by conservative estimates.
Equally encouragingly, the year-to-date figures (September 2013)
from the KPIs for AvLOS, DOSA and re-admission in 2013 Hospital
Performance Report shows impressive delivery on NPS targets.
A 4.5 per cent hospital-specific AvLOS (Average Length of Stay)
reduction target has been set for this metric for each hospital 62
per cent of hospitals surveyed were on, or exceeding, target; 26 per
cent of hospitals were within 10 per cent of target; and 12 per cent of
hospitals were more than 10 per cent off target.
The DoSA (Day of Surgery Admission) metric measures the
percentage of elective surgical patients who had principal procedure
conducted on day of admission. Again, the DoSA targets are hospital-
specific and aim at a 15 per cent increase on the 2011 figure. In this
instance, 47 per cent of hospitals were on, or exceeding, target; 24 per
cent were within 10% of target; and 29 per cent were more than 10
per cent off target.
Hospital-specific targets for re-admission rates (i.e. 30 days post acute
or elective, inpatient or day-case surgical admission to same hospital
for care associated with original admission) aimed at a target of under
3 per cent. Of all hospitals surveyed, 97% achieved the target.
"While we are still in the early stages of a transformative process,
these results are very positive. To have almost 90 per cent of hospitals
within 10 per cent of AvLOS targets, over 70 per cent of hospitals
within 10 per cent of DoSA targets and almost 100 per cent on
target for admission rates, is hugely encouraging and provides a solid
foundation for future progress," Mr Mealy commented. "We have to
remember too, the real benefits behind the targets. These figures are
not just numbers on a page, they translate into more focused use of
resources to provide better treatment for patients. The reduction in
re-admission rates, for example, indicates enhanced performance
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