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National

Dashboard > Pre-Procedure Non-Elective Bed Days


 

Pre-procedure bed day rate 1.58
Opportunity £58,347,594
Volume Opportunity 285,909
Rank 1

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Treatment Function Pre-procedure bed day rate Financial Opportunity Volume Opportunity Rank
General Medicine 1.84 £12,432,459 62,472 1
Geriatric Medicine 3.03 £5,544,182 28,924 1
General Surgery 1.05 £4,112,354 19,607 1
Cardiology 1.97 £3,542,394 17,723 1
Trauma & Orthopaedics 1.17 £3,431,596 16,043 1
Gastroenterology 3.45 £3,327,490 16,482 1
Accident & Emergency (A&E) 0.54 £2,341,984 11,352 1
Respiratory Medicine (Thoracic Medicine) 2.78 £2,137,046 11,288 1
Nephrology 2.53 £1,266,512 6,474 1
Paediatrics 0.60 £1,125,146 4,012 1
Urology 0.86 £1,045,304 5,115 1
Stroke Medicine 1.25 £1,015,793 5,114 1
Vascular Surgery 2.94 £983,673 4,624 1
Critical Care Medicine 2.20 £960,373 4,805 1
Clinical Haematology 2.31 £912,063 4,270 1
Interventional Radiology 4.72 £829,684 4,059 1
Rehabilitation 7.82 £805,767 4,714 1
Neurosurgery 1.72 £788,538 3,844 1
Medical Oncology 1.61 £785,916 3,909 1
Diabetic Medicine 3.09 £743,015 3,887 1
Colorectal Surgery 1.36 £702,565 3,396 1
Upper Gastrointestinal Surgery 1.67 £645,951 3,070 1
Endocrinology 3.21 £606,235 3,082 1
Neurology 1.25 £603,369 3,009 1
Clinical Oncology (previously Radiotherapy) 1.99 £584,811 2,939 1
Ear, Nose & Throat (ENT) 0.58 £583,015 2,575 1
Gynaecology 0.43 £578,676 2,400 1
Plastic Surgery 0.40 £509,122 2,399 1
Paediatric Surgery 0.86 £432,620 1,571 1
Cardiothoracic Surgery 2.97 £318,408 1,613 1
Rheumatology 2.47 £300,890 1,482 1
Hepatology 3.07 £260,112 1,263 1
Hepatobiliary & Pancreatic Surgery 2.24 £237,188 1,156 1
Cardiac Surgery 3.57 £233,825 1,171 1
Ophthalmology 0.35 £233,334 972 1
Infectious Diseases 3.30 £223,985 1,156 1
Maxillo Facial Surgery 0.60 £215,902 924 1
Paediatric Trauma and Orthopaedics 0.62 £211,825 875 1
Oral Surgery 0.48 £183,964 771 1
Paediatric Respiratory Medicine 4.48 £157,677 580 1
Neonatology 0.87 £154,097 557 1
Spinal Surgery Service 1.45 £151,637 724 1
Palliative Medicine 3.94 £145,385 746 1
Paediatric Neurosurgery 2.46 £138,855 620 1
Paediatric Cardiology 2.44 £135,514 519 1
Paediatric Gastroenterology 2.60 £120,155 427 1
Paediatric Intensive Care 1.54 £113,780 430 1
Transplantation Surgery 3.18 £105,928 538 1
Dermatology 3.50 £105,371 508 1
Paediatric Medical Oncology 0.99 £104,136 420 1
Thoracic Surgery 1.90 £92,499 483 1
Paediatric Ear Nose and Throat 0.71 £88,231 299 1
Anaesthetics 1.73 £83,525 397 1
Transient Ischaemic Attack 1.05 £74,014 368 1
Gynaecological Oncology 1.34 £68,632 312 1
Paediatric Clinical Haematology 1.17 £66,802 250 1
Paediatric Plastic Surgery 0.19 £66,622 293 1
Paediatric Cardiac Surgery 3.72 £54,116 255 1
Paediatric Neurology 1.34 £53,316 196 1
Pain Management 1.63 £52,540 273 1
Breast Surgery 0.85 £50,578 246 1
Burns Care 5.29 £43,516 228 1
Obstetrics 0.51 £43,277 445 1
Paediatric Nephrology 2.10 £43,093 158 1
Clinical Pharmacology 2.07 £40,153 211 1
Spinal Injuries 3.97 £32,207 155 1
Paediatric Endocrinology 7.42 £24,417 89 1
Paediatric Urology 0.53 £22,941 72 1
Respiratory Physiology 2.97 £20,667 107 1
Paediatric Infectious Diseases 1.88 £17,765 62 1
Diagnostic Imaging 1.76 £12,670 58 1
Congenital Heart Disease Service 3.50 £9,110 50 1
Paediatric Ophthalmology 0.53 £6,255 23 1
Genitourinary Medicine 1.65 £5,341 27 1
Haemophilia 0.22 £5,327 24 1
Bone & Marrow Transplantation 1.59 £5,211 43 1
Paediatric Maxillo-facial Surgery 0.13 £4,841 17 1
Chemical Pathology 1.00 £4,331 21 1
Paediatric Rheumatology 1.28 £4,148 15 1
Paediatric Diabetic Medicine 0.92 £3,456 12 1
Paediatric Metabolic Disease 2.25 £3,154 14 1
Clinical Immunology 4.80 £2,979 14 1
Paediatric Burns Care 0.64 £2,095 9 1
Paediatric Dentistry 0.42 £1,482 5 1
Paediatric Interventional Radiology 2.45 £1,211 5 1
Clinical Immunology & Allergy 0.71 £1,090 5 1
Medical Ophthalmology 0.57 £968 4 1
Clinical Genetics 1.67 £943 5 1
Restorative Dentistry 1.67 £940 5 1
Midwife episode 0.11 £814 34 1
Allergy 0.14 £596 3 1
Paediatric Epilepsy 0.50 £576 2 1
Podiatry 0.40 £414 2 1
Physiotherapy 0.29 £410 2 1
Paediatric Dermatology 0.75 £288 1 1
Cardiothoracic Transplantation 0.17 £211 1 1
Orthodontics 0.17 £206 1 1
Audiology - - 0 1
Clinical Neurophysiology - - 0 1
Clinical Physiology 1.50 - 0 1
Community Paediatrics - - 0 1
Dental Medicine Specialties - - 0 1
Optometry - - 0 1
Orthoptics - - 0 1
Paediatric Audiological Medicine - - 0 1
Paediatric Clinical Immunology and Allergy - - 0 1
Paediatric Gastrointestinal Surgery - - 0 1
Sport and Exercise Medicine 0.51 - 0 1
Tropical Medicine 1.67 - 0 1

Hospitals should aim to minimise the time between patients being admitted to hospital and having an operation. Steps can be taken to improve the process for emergency patients as well as elective ones.

All emergency patients who have undergone a recognised procedure are included in this analysis. However we are not able to tell from the data alone whether the procedure was the main reason for admission or whether they were admitted for something else and subsequently had a procedure. Therefore this indicator should be treated with some caution. It may be better to concentrate your attention on surgical specialties unless you have local intelligence to suggest otherwise.

While access to emergency care has improved considerably in the NHS, further attention is now required to ensure that only those patients who actually require admission to an acute hospital bed are admitted and that their length of stay is commensurate with their acute care needs. Emergency patients can also benefit from the pre-assessment process.

A reduction in pre-operative bed days by means of rapid pre-op assessment once admitted, protocols and local diagnostic work-up will help reduce acute bed days. Such pre-operative assessment (POA) and planning, ensures that the patient is fully informed about the procedure and the post operative recovery,

There are wide variations between trusts in their management of emergency patients. The proportion of patients with broken hips operated on within two days of admission varies from 22% to 100%. With these patients, rapid treatment is not simply an issue of efficiency but also of quality of care, as rapid treatment is associated with better outcomes.

Key steps :

  • Monitor the number of days between admission and operation for key groups of emergency patients, such as Orthopaedic patients. Identify those surgical specialties where the time to surgery is out of line with peers.
  • Review procedures for assessing, stabilising and scheduling emergency admissions for surgery to minimise delays. Processes should be designed to assess emergency patients as fully as possible prior to admission rather than admitting patients to assess them. Assessment facilities located within specialty areas are an effective way of achieving this.

Further Information

NHS Elect – Service Transformation Tools

http://www.nhselect.nhs.uk/Service-Transformation

Information Shown

This indicator is the pre-procedure length of stay. It is expressed as the sum of all the bed days between the date of patients emergency admission and the date of their primary procedure divided by the number of hospital spells.

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