Aims
North-west London hospitals were designated as first-wave rollout sites for NHS England's ‘7-day services’ clinical standards. Our aim was to determine clinical outcomes (improved patient flow, reduced length of stay, reduced in-hospital morbidity) and pilot new care models designed to meet those outcomes. Recognising the value of the entire multidisciplinary team to deliver these standards was an important guiding principle.
Methods
Define key clinical and operational outcome measures and determine how to collect this data.
Clinicians to define core characteristics of a new care model that are thought to be important in meeting the key outcomes (daily patient stratification, daily consultant-led board rounds, 7-day consistency).
Invite teams in different acute hospitals to submit bids to run 6–8 week pilots based on local service needs.
Analyse data from pilots and use results to influence business cases to further improve services.
We ran a number of pilots, including:
Hillingdon Hospital elderly medicine – 7-day consultant-led board rounds and 7-day therapies
Northwick Park Hospital – 7-day pharmacy cover for acute medical unit and hospital discharges
St Mary's Hospital orthopaedics – 7-day physician/ ortho-geriatrician cover and 7-day therapy
Chelsea and Westminster elderly medicine – 7-day therapies.
Results
- Hillingdon elderly medicine:
- 1-day length of stay reduction on wards (12% reduction)
- patients discharged on average 1–2 hours earlier in the day
- improved staff satisfaction.
- Northwick Park pharmacy:
- fewer medication discrepancies
- improved staff satisfaction.
- St Mary’s orthopaedics:
- 16% reduction in length of stay
- earlier identification of unwell patients
- improved staff satisfaction.
- Chelsea and Westminster therapies:
- 10% reduction in length of stay
- shorter time to ‘first contact’ with a therapist from admission
- improved staff satisfaction.
Conclusion
Seven-day services has been a politically sensitive topic in health service development. Using a clinically led, outcomes-based approach has allowed hospitals in north-west London to demonstrate a positive impact on patient flow and, importantly, on staff satisfaction. It is important to note that our interventions used multidisciplinary staff members. Using short-term pilots as a springboard for business case development while simultaneously engaging executive, operational and clinical leadership teams has proved fruitful.
Conflict of interest statement
None.