Factors affecting patient flow in a neurosurgery department

Area of Science:

• Neurosurgery
• Healthcare Management
• Geriatrics

Background:

• Patient flow is crucial for clinical productivity and efficient healthcare delivery.
• The NHS Improvement SAFER patient flow bundle and Red2Green initiative aim to optimize patient movement.
• Frailty is increasingly recognized as a factor impacting patient care pathways.

Purpose of the Study:

• To implement and evaluate the NHS Improvement SAFER patient flow bundle.
• To assess the impact of the Red2Green initiative on patient flow.
• To determine the influence of frailty on patient flow within a neurosurgery unit.

Main Methods:

• Prospective data collection for all neurosurgery admissions over three months.
• Inclusion of patient demographics, length of stay, discharge details, and frailty assessment (Rockwood Clinical Frailty Scale).
• Analysis of 'red days' (delays) and their attributed reasons, with cost analysis using NHS reference costs.

Main Results:

• 21% of total bed days were 'red days,' disproportionately affecting emergency admissions.
• 63% of delays were due to awaiting local hospital beds.
• Frail patients had significantly longer stays and more red days, contributing to substantial costs.

Conclusions:

• The SAFER bundle identified key areas for patient flow improvement and associated costs.
• Implementation facilitated discussions within the referral network.
• A geriatric liaison service was identified as a potential solution to address frailty-related flow issues.