“POP Clinic”: New tool to improve admissions to surgery
David O’Regan, consultant cardiothoracic surgeon in the Yorkshire Heart Centre, recently presented his work at the national QIPP challenge event in Manchester to an influential audience of clinicians and managers from across the country. QIPP – Quality, Innovation, Productivity and Prevention – is a large scale transformational programme which aims toimprove the quality of care the NHS delivers nationally while making up to £20 billion of efficiency savings by 2014-15, which will be reinvested in frontline care.
The “POP clinic” pre-admission process designed by Mr O’Regan delivers overall savings of around £130,000 every year;principally by significantly reducing the number of bed days his patients spend in hospital as well as by substituting operations to improve efficiencies. Since it started it has saved nearly £1.5 million and saved over 2000 bed days.
This has been achieved with improved clinical outcomes, lower than average readmission rates, and extremely good feedback from patients and staff working within the team. The key to the process is co-ordinating care across organisational and professional boundaries by maximising the input of the multi-disciplinary team who see the patient, involving the consultant surgeon together with a junior doctor, rehab, ward and OP ward nurses, an anaesthetist and ITU representative, plus social services. This includes management of the patients’ risk - with input from a dietician, physiotherapist and pharmacist, lifestyle and smoking advice, to ensure as much as possible has been considered prior to admission, and empowering the patient to feel involved in the process and confident they have met the whole team who will be treating them. At the same time follow-up needs are identified which means the process can continue smoothly after discharge.
Mr O’Regan explained: “The aim is to bring all the actors together at the start of the pathway, with one point of entry to the process. This means patients don’t get admitted until everyone involved – including the patient - is confident that everything is sorted and surgery can proceed.
“Patients then choose a date for surgery and we also set a discharge date at the same time, so they can make plans for their stay just as they would for any other service in the commercial world, for example booking a flight and a holiday.” The process also involves patients who have already undergone surgery in coming along to pre-admission clinics for new patients.
They wear a “smiley face” badge to indicate who they are and that they are happy to talk, meaning our patients get the benefit of hearing first hand from others who have been through the process, which provides important reassurance. Sarah Hartley, Mr O’Regan’s secretary, feels the clinic has helped create better personal job satisfaction through interaction with patients and them feeling more confident about the process. “I feel theworst part of my job as a secretary is when I have to cancel patients for one reason or another,” she said.
“The Pop-in clinic has made this a lot easier. Patients are more relaxed about the change, they have seen the consultant and ward staff and are reassured. On the other hand, when I need to bring a patient’s admission dates forward they are not put into a blind panic - as they are fully prepared, having had everything explained to them in the clinic.” the model was developed by Mr O’Regan from an MBA thesis he completed in 2005, and has been refined since then totake into account changing circumstances such as a more complex case-mix. The process has been extensively audited
all stages to assess clinical outcomes and patient satisfaction as well as the savings which come out of patients spending lesstime in hospital as a result of all the workundertaken to ensure they are ready forsurgery when they are admitted.It is hoped the model will be rolled outwith new colleagues of Mr O’Regan in the Yorkshire Heart Centre, and that some of the lessons learned here in Leeds can also help improve patient care nationally
David O'Regan Background
Mr O'Regan graduated from Southampton University in 1985. He began his career as a general surgeon but changed to cardiothoracic surgery whilst on a rotation at the John Radcliffe Hospital in Oxford. He then joined the Royal Brompton Hospital, cardiothoracic rotation in 1992. Mr O'Regan was appointed to Leeds General Infirmary in November 2000 and took up the post in February 2001. His training has been in adult cardiothoracic surgery with a special focus on adult cardiac work.
Mr O'Regan ensures all his patients have been risk stratified and entered on a clinical management system which provides real time performance information. This is available on request.
Mr O'Regan's research interests are concentrated on vascular biology including endothelial cell responses to injury.Mr O'Regan is also interested in organisational behaviour.
Mr O’Regan’s professional interests include teaching, management, audit and the use of IT in healthcare systems.
Mr O'Regan completed a doctorate in medicine entitled 'Activated Protein C as a logical adjunct to Heparin and Cardiovascular Intervention' and was awarded by the Imperial College in 2000.
He was president of the Association of Surgeons in Training from 1999-2000. He has since initiated and continue to run the Silver Scalpel Award to identify the best surgical trainers in the land.
Mr. O'Regan has a keen interest in patient safety and quality.