Whittington Health NHS Trust
Creating capacity, improving patient experience, and avoiding excess costs
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Whittington Health NHS Trust needed to reduce the length of time patients stayed in hospital beds in order to meet the increased demand during winter, and to free up capacity for a dedicated haematology ward. Against a backdrop of national strike action, we worked with the Trust to discharge patients faster, free up beds, and improve patient outcomes while saving money.
Whittington Health NHS Trust – which manages the Whittington Hospital and serves several North London boroughs – was impacted by national challenges including waiting list backlogs, rising demand for beds, and the need to work within a challenging financial context. These problems were further exacerbated by people staying longer in hospital post COVID-19.
With winter looming and demand for beds set to increase significantly, the Trust needed to reduce the average length of stay by more than half a day to help meet demand and free up capacity for a specialist haematology ward – something vitally important to the Trust and its local patient population.
Relieving pressure
Even before the pandemic, there was evidence of NHS bed shortages and longer hospital stays, but in the years since, the situation has not stabilised. This contributes to poorer patient outcomes and puts pressure on other departments such as A&E where patients can wait hours for a bed to become available.
To better support their patients, and meet budget and efficiency targets, integrated Trusts such as Whittington need to reduce patient stays and prevent unnecessary admissions to free up existing beds.
Many patients were staying in hospital longer than they needed to, as with the rest of the country, and the Trust needed to make sure that they were utilising those beds in the right way.”
In addition to these pressures, the Trust’s diverse patient population means the hospital treats the largest number of people with the blood disorder Thalassaemia in England, and desperately wanted to create a specialist haematology ward to support patient demand. By freeing up more beds, the Trust could improve the care and experience of patients with Thalassaemia and sickle cell anaemia and reduce the area’s healthcare inequalities.
One of the problems we wanted to solve was to right-size the bed base for different medical specialties including a home for haematology so that the patients were cared for in the best way possible.”
Accelerating change in 50 days
Working alongside Whittington Health’s leaders and key clinicians, we co-designed an intensive 12-week discharge plan to reduce the average length of stay in hospital beds.
Our operational, clinical, and data experts combined to work directly with patient-facing staff to develop and determine the interventions needed to bring down the length of stay. Using data from the Trust, we implemented better functioning assessment wards; increased admissions with virtual wards same-day emergency care; better discharge planning and best practice procedures; and ways to relocate patients who no longer need an acute care bed.
Our approach was launched with the ‘50-day discharge accelerator’, a toolkit supporting the team in these discharge pathways, able to fast-track the process of discharge of patients, helping to drive flow, productivity and alleviate pressure faced by staff.
The PA team helped us implement a six-step approach to improve flow of patients in and out of hospital. These steps included diagnosing, defining, delivering, validating, monitoring, and realising the benefits of interventions, all geared towards reducing the length of stay.”
This is a great example of how looking at your numbers, understanding your data and looking at what the drivers are of productivity, you can make a real productive difference.”
Reducing length of stay and freeing up beds
Over the 12-week period, we reduced the average length of stay by over half a day. We achieved this by increasing bed capacity through reducing patients’ length of stay to less than 48 hours and reducing waiting times by increasing the number of daily discharges by 50 percent. Not only did this improve patient experience, it has also saved two million pounds for the Trust.
Before we began, I don’t think some people believed it was possible. They were given a real sense of hope through the programme and the way in which we completely co-designed this with them.”
The Trust has since doubled the morning discharge rate by introducing afternoon huddles to identify which patients could be discharged the following day, and the average number of patients staying seven days or more fell by over 40 per week. Those staying 21 days or more fell by 20 per week.
The impact has been widespread across the hospital but most notably felt in the Emergency Department (ED) which reported fewer patients spending anything over 12 hours in ED.
Beyond this, staff reported a renewed sense of hope and empowerment as a result of the programme, which came during peak winter pressures and NHS strike action.
Working with the PA Consulting team was amazing, and the outcomes were brilliant for both patients and staff.”
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