Reducing Length of Stay at West Middlesex University Hospital NHS Trust

6th September, 2011

West Middlesex University Hospital is close to Heathrow, London. High average length of stay (ALOS) was the biggest contributor to their financial deficit in 2009-10. RealTime Health reduces length of stay through the enablement of clinical best practice. At WMUH we worked on reducing length of stay by transforming the management of patient flow, discharge planning, and inter-agency collaboration.

The Challenge

West Middlesex University Hospital is a district general hospital close to Heathrow, London. High average length of stay (ALOS) at WMUH was the single biggest contributor to the Trust’s financial deficit in 2009-10, with many patients staying over 20 days and a number staying over 100 days. With the deficit standing at £13M p.a., reduction in ALOS was a key objective in the 2010-11 Cost Improvement Programme. This objective was recognised by NHS Hounslow, and procurement of an electronic system to facilitate discharge planning became a local CQUIN for 2010-11. The deadline for introducing the new system was Q3 2010.

High ALOS also affects the quality of care, with the clinical impact on patients including an increased risk of infection, disorientation, and a reduced chance of returning to pre-admission status. High ALOS also leads to high bed occupancy levels, which further exacerbates the status quo by significantly reducing the likelihood of caring for patients in the right place – all of which becomes even more difficult to manage in the drive towards instituting single sex accommodation on the wards.

The Solution

With the green light for procurement happening in April 2010 – concluded in July 2010 – and a ‘go live’ deadline in October 2010 backed up by the requisite process change in parallel on the wards, WMUH had an exceptionally challenging road to travel.

RealTime worked closely with the Trust to deliver the project within the 3 month window allocated, and formed a detailed project plan outlining all of the core deliverables.  In collaboration with RealTime, the Trust set up an implementation team on the hospital wards to deliver the project to deadline, and put an IT training and support programme in place for staff.

RealTime went live on October 9th 2010, and phase one of the project was completed by December 14th 2010.  During this two month period, the software was implemented on two wards at a time, and subsequently rolled out across 11 wards.

Throughout the implementation stages, RealTime were readily available to help the Trust with any issues, and welcomed them into the RealTime User Group so that they could benefit from the support of an interactive community focusing on knowledge share and user experiences.

The Results

The results at WMUH are impressive. They switched their RealTime system on in October 2010 having experienced 2x parallel projects of 12 weeks each to transform clinical process and to configure and integrate the software tools. They closed 2x wards before Christmas 2010 (46 out of 350 beds) and another ward in 2011, reducing the total number of open wards from 11 to 8. Admissions levels actually increased by 15% compared to the previous year, but the pressure and stress levels have been eliminated because they now have a healthy discharge rhythm and full visibility of all patient flow issues trust-wide 24×7, including full interaction with social services every step of the way (NHS Hounslow have moved on site now). WMUH is transforming the way the hospital works and is seeing real benefits very rapidly. It is a great testimony to the importance of the clinical process improvement underpinning the RealTime deployment – patients are being discharged earlier and fitter, and this is bringing down the cost of delivering high quality healthcare.

The first winter escalation at WMUH despite a reorganisation of their entire bed stock before Christmas was in late January 2011.

The Testimony

At the invitation of the UK Government’s Department of Health, Cambridge University Hospitals NHS Foundation Trust (CUH) and WMUH gave a seminar at the Healthcare Innovation Expo event at the ExCeL centre in London, March 2011, about how RealTime is reducing length of stay by ensuring that patients are clinically fit for discharge at the earliest possible point. This was a great talk as it provided the ‘why RealTime?’ story from CUH and the ‘here’s how it worked for us’ testimony from a DGH.

“We looked at a number of systems to help us improve the flow of patients through the hospital and chose RealTime because it is simple for staff to use but very powerful in what it offers. It has helped hospital staff to focus more clearly on planning discharges and ensure that any obstacles or delays have been avoided or minimised.” Dr Stella Barnass, Medical Director.

“RealTime Health Ltd staff have been very responsive and have demonstrated great flexibility when addressing our needs. Being part of an enthusiastic user group is a significant plus and we have established good relationships with RealTime’s other clients.  We’ve learnt about their experiences and benefitted from a variety of approaches and advice which has been instrumental during the implementation process.” Tessa Longney, Head of Discharge and Capacity Services.

“Despite reorganising our entire bed stock in the month before Christmas, we have had a much more controlled period than was the case in previous years.  RealTime allows us to marry resources with needs and has enabled a healthy discharge rhythm. It has improved forward planning and made it much easier for us to identify problems, allowing for a quicker response and enhanced stability.” Simon Marshall, Chief Financial Officer.