Introduction There appears to be growing evidence that increasing consultant-led multidisciplinary team (MDT)-delivered care is associated with better patient outcomes, quicker decision making and more efficient uses of resources. There is still inconsistency across different hospitals, on how consultant led care can be best delivered when treating inpatients. Our hypothesis was that compared to a five single on call day service by separate Cardiologists, a consultant-led oncall week which consists of a twice daily inpatient ward round by the same consultant would improve patient outcomes in terms of discharge rates (DRs), length of stay (LoS), inpatient mortality rates (MRs) and readmission rates (RRs).
Settings Good Hope Hospital is a 521 bed district general hospital with 6 consultant cardiologists, and has an inpatient capacity of 6 CCU and 22 cardiology beds. Traditionally, all patients on CCU as well as new patients on the ward were reviewed by the on call consultant who was on call on a set day of the week. After the initial post take ward round, these patients were seen on a twice weekly basis by their admitting consultants and were looked after by junior doctors In the interim.
Methods This was a retrospective observational study of inpatient average length of stay and discharge rates between April 2012 to March 2015 and included the data of 3289 patients. The intervention was implemented on 1st November 2013. All data were collected by the hospital IT department on a daily basis and reported on a monthly basis. We compared the inpatient MRs and RRs to assess any adverse effects on the quality of patient care. Statistical analysis was performed using student T-test. The p value <0.005 was considered significant. Results are expressed as means ± SD.
Results The data of 2058 patients prior to the consultants of the week method were compared to 1771 after the change. The monthly means ± SD of discharge rates, length of stay, readmission rate and mortality rate are shown in table 1. There is a significant increase in discharges and reduction in length of stay following the intervention. Despite a 15% increase in patient discharge rate, the readmission rate and inpatient mortality rate did not change significantly.
Conclusions Focused daily consultant input has a significant impact on reducing inpatient length of stay, ensuring timely discharges, and saving the NHS resources in bed days and creating more beds available for new admissions.
- consultant-led service
- discharge rates
- length of stay
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