Improving quality in a national intestinal failure unit: greater efficiency, improved access and reduced mortality

Problem: In 2010, there was a significant waiting list for admission to the intestinal failure unit (IFU) at the Salford Royal National Health Service (NHS) Foundation Trust. There had been a steady increase in the number of new patients referred to the IFU (89 patients 2005; 152 patients 2012) and the number of established patients requiring home parenteral nutrition (HPN) (135 patients 2005; 206 patients 2012) over the last decade. The impact of the resulting long waiting list for these complex patients was that patient deaths occurred in those awaiting admission.

Design: Continuous improvement methodology using the model for improvement and sequential plan-do-study-act cycles.

Setting: Salford Royal NHS Foundation Trust IFU; a large NHS teaching hospital in Northwest England.

Key measures for improvement: The primary outcome measures were inpatient length of stay and time spent on waiting list prior to admission.

Strategies for change: A continuous improvement programme, supported by a project manager.

Results: There has been a 21% reduction in average length of stay on the IFU from 55.7 to 44.0 days and a reduction of 72% in the average length of time new patients spent on the waiting list for admission from 65.7 to 18.5 days. These changes were associated with concomitant reduction in 30-day readmission rate from 12.1% to 4.5% and early suggestions of reduced inpatient and waiting list mortality.

Conclusions: It is possible to improve the efficiency of a large national service for complex patients using quality improvement methodology, resulting in improved access and reduced waiting list mortality.