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Background Norfolk and Norwich University Hospital (NNUH) is a busy teaching hospital with over 1000 beds and can have up to 40 patients a day triaged to Older Peoples Medicine (OPM). NNUH also admits close to 800 fracture neck of femur (NOF) patients a year.
Due to the large volume of admissions especially over weekends there could be up to 24 hour delay in patients being seen by a geriatrician on post take ward round (PTWR).
Innovation We proposed a service model which entailed having an extra consultant geriatrician for 3 hours and a junior doctor for 8 hours on each weekend day. The extra funding for the above service commitment was secured against the anticipated financial gain from achieving the NOF BPT target. Their responsibilities were to review all new fracture NOF patients and an expectation to assist on PTWR duties, which was fulfilled.
Evaluation During the six months of running this new service model we have managed to bring down the PTWR time and guaranteed a geriatrician review for OPM patients within 20 hours of admission. This has not only improved quality of care it has also improved patient flow over the weekend. The discharges over the weekend have increased from 12% to 14% and the overall departmental length of stay has gone down from 9.7 days to 9.3 days. We have improved our BPT target of geriatrician review of fracture NOF patients within 72 hours from 86% to 95%
Conclusion The above service development model illustrates how BPT funding can be utilised to improve overall patient care. This service model not only has the potential to improve patient care for fracture NOF patients the benefits were extended to all OPM patients. This is in line with the aspirations of introducing BPT, which is ‘high quality care for all’, Lord Darzi's NHS Next Stage Review report.