Doing better, costing less
Clinical governance has always been inextricably linked with the concept of continuous improvement but often associated with practice reforms that cost more money. It was interesting, therefore, to see the analysis from the Dartmouth Atlas Project that shows that there is no correlation between spend and outcome. This issue reports on five studies where in fact better practice could cost less and still improve patient care.
Thomas et al. explores the patterns of referral, reasons for admission or discharge from acute medical assessment/admission units and the reasons for longer lengths of stay. It is interesting to see that there is evidence that an opportunity for early intervention, to prevent admission, exists in a significant proportion or patients that could have resulted in keeping people in their own homes.
Hindley on the other hand found that the routine use of intrapartum electronic foetal monitoring has resulted in an increased burden of operative and vaginal instrumental deliveries for women at low obstetric risk. The findings suggest that this defensive practice relates to midwives attempting to manage the psychological burden of the threat from clinical negligence, practice that increases mortality and morbidity risks.
Rajjayabun has demonstrated that, by rapid implementation of a simple reproducible and comprehensive process of documentation, meaningful improvements in the standards of care for patients with high-risk superficial bladder cancer can be achieved. Using a similar approach, Karthikayan et al. demonstrate that a validated tool used to assess client satisfaction with a one-stop cataract pre-assessment service achieves significant improvements in patient satisfaction.
Natangelo’s paper is the first to report the results of an assessment process of complaints lodged via an independent citizens’ association in Italy. The study showed that hospital managers often failed to undertake a systematic investigation, leaving complainants dissatisfied with both the process and the outcome.
Finally, Basu et al. examines a case of variance in care using the NICE guidelines on antenatal anti-D prophylaxis in maternity units. A total of 18 maternity hospital units were surveyed about their existing practice five years after the publication of the guideline. Only 11 units were compliant, in non-user units cost appeared to be the most important factor without any reference to the cost of non-compliance.
Five studies all suggesting we could do better without necessarily increasing costs.
Jeff Lucas
