Northampton General Hospital NHS Trust

Northampton, UK




Transforming patient care and hospital services

Until now, effective capacity planning and bed management have been challenging problems for Northampton General Hospital (NGH), but by discovering the benefits of the unique CapPlan consulting and software solution, NGH is on the road to transforming the way it manages inpatient demand, from admission to discharge.

In addition, the CapPlan project has identified significant potential cost savings.

For the first time, Northampton General Hospital (NGH) has the ability to accurately forecast inpatient demand, across all wards at any time. From predicting peak periods to managing pandemic outbreaks, CapPlan provides accurate real-time information that will help achieve NHS targets.

The challenge

Like many hospitals, NGH struggles to forecast and manage inpatient bed requirements. Forecasting is a manual and time-consuming task, both inaccurate and inefficient. The inability to predict demand beyond the next 24 hours has a detrimental impact upon the whole hospital, from staff directly involved with patient care to administrators trying to reconcile targets and finances and identify sustainable cost-saving opportunities.

While the hospital has developed a comprehensive strategy for continuous improvement, inpatient Length-of-Stay (LoS), staff rota inefficiencies and the cost of employing temporary agency staff remain major issues.

In effect, planning needs for the next 24 hours are holding everyone back and undermining the continuous improvement strategy. Unless improved bed management and capacity planning can be genuinely and practically achieved, it could jeopardise the delivery of such a strategy.

CapPlan

CapPlan is a unique capacity planning, forecasting and consulting solution delivered by Emendo Ltd. Its central benefit is to focus on patient flow, providing the ability to accurately predict inpatient demands from surgery and medical ward requirements to recurring peaks such as winter flu outbreaks, or responding to pandemics such as swine flu.

CapPlan Discovery

CapPlan Discovery projects usually last two months and provide hospitals with the opportunity to understand how CapPlan works in practice. They can identify and evaluate where to make changes that will aid their future planning, decrease their costs and improve patient care, before committing to a full implementation of the CapPlan system.

Emendo and NGH

In March 2009, NGH asked Emendo Ltd to conduct a CapPlan Discovery project. In particular, NGH wanted to understand how CapPlan could help with specific problems:

  • Winter planning
  • Length of Stay (LoS)
  • Bed footprint
  • Discharges
  • Flu pandemic.

Consequently, the objectives of the Discovery project included:

  • Creating an accurate forecast of beds required – in terms of occupancy, patient flow and LoS – for the coming winter period
  • Providing a resource plan for the efficient rostering of nurses, healthcare assistants etc, which also ensured staffing levels could be met and cost-savings identified
  • Demonstrating accurate staff forecasting set against the use and expense of bank and agency staff
  • Reviewing how reducing LoS and improving discharge time of day would impact on available inpatient bed capacity
  • Showing the impact of improving LoS to upper quartile measurements
  • Demonstrating how to increase the number of patients discharged from inpatient wards by midday each day
  • Reviewing the hospital bed footprint
  • Reducing outliers as a percentage of occupancy by realigning the specialties and the wards to ensure the correct number of beds are available for each group.

Our solution

Our Discovery project homed in on the unique characteristics of NGH. The CapPlan team worked with a team of NGH staff in a programme of joint learning; for us to understand the hospital’s issues and bed management process; and for the staff to understand how CapPlan works in detail. An extract of four years’ data from the Patient Administration System was cleansed and uploaded into the CapPlan system. The CapPlan team then analysed it, focusing on key areas of improvement identified by clinical and operational NGH staff. The findings were communicated to the NGH team in a series of presentations and workshops over the course of the project, to help clarify assumptions and promote discussion and feedback. This collaborative approach was absolutely key to gaining a strong understanding of the NGH bed management processes and the flow of patients through the hospital.

Project results

The project results were presented in a final on-site workshop session, along with a comprehensive report. The session enabled NGH staff to see CapPlan in operation with their own data and discuss how best to take these results forward as part of their improvement programme.

The results provided:

  • A winter forecast and associated Christmas bed plan with resources matched to the forecast. More staff could take annual leave and there would be a reduction in the need for agency staff as bed requirements are known well in advance
  • Potential efficiency savings of approx £690k in the first year of CapPlan operation, calculated by multiplying the Occupied Bed Day (OBD) cost by the opportunities to match bed requirements to peak expected demand
  • Data demonstrating current status, opportunities and recommendations across all inpatient areas of the hospital
  • Models showing the impact of patient flow improvements in financial and resource management terms
  • Bed requirements for each specialty, facilitating discussions of resource allocation.

We also provided detailed information in other key areas:

Discharges: We highlighted the current discharge rate of patients from inpatient wards before midday and by 4pm. This showed the impact on the flow of incoming patients into available beds on the correct wards and how that increased the number of outliers. Different discharge behaviour at weekends was also causing peaks in occupancy and variable workloads.

LoS: We provided the data to demonstrate how limited discharges at weekends had a direct impact upon patients’ LoS – the number of patients staying over 10

days increases, along with an increase in the number of occupied beds. We also identified which days have the highest average LoS.

Further data demonstrated:

  • Trends in LoS discharges by midday, defined by medical and surgical planning groups
  • The LoS profiled against the national average and the upper quartile. This indicated that significant savings of over £5m could potentially be made if the upper quartile was achieved across all specialities
  • Pandemic scenario planning (based on DoH guidelines) – combined with the inpatient forecast to provide a view of the overall demand each day.

CapPlan recommendations

The CapPlan combination of consultancy, software and collaborative working means we are able to support results with meaningful recommendations.

For NGH, these included:

  • Suggested alternative bed allocation by speciality to assist with long-term planning
  • To increase the percentage of discharges to 50% before midday, resulting in additional beds becoming available for admissions. This would improve the efficiency of transfers from A&E, helping them comply with their targets
  • To increase use of the discharge lounge, particularly before midday, making this a more cost-efficient service to run
  • Reviewing the discharge behaviour during the week which is causing peaks in occupancy and variable workloads. Resources could be planned against these variations and peaks, for better patient flow and work patterns, including A&E requirements
  • Bed management decisions on resource requirements need to take into account actual and projected occupancy for the next five days, as well as the long-term forecast.

Next steps

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