SAVING COSTS IN
TRANSPORT FOR
DIALYSIS PATIENTS
September 2010
Sr Maggie Farrell, Senior Sister
Mrs Jacqueline Tansley, Senior Dialysis Renographer
Dr Patrick Harnett, Consultant Physician
Southend Hospital Renal Unit
INTRODUCTION
• Haemodialysis patients are required to attend the renal
unit frequently and regularly for dialysis treatment
• These patients are often dependent on hospital transport
to enable them to attend for their treatment
• The introduction of new practices on The Renal Unit at
Southend University Hospital has improved the service
as well as significantly reducing transport costs
PROBLEM
• Cause of patient complaint
• Long waiting times for patients
• Patient addresses over wide area
• Uncoordinated journeys
• Pressure on hospital transport services
• Increasing transport costs
METHODOLOGY
• Mobility status reassessed for all patients on
ambulance transport
• Geographic data was collected and mapped
• Data was analysed and patients were
regrouped into closest postcode areas
• Individual patients spoken to re changes
METHODOLOGY cont
• Letter sent to patients informing them of
proposed changes
• Systematic approach used to coordinate patients
days and treatment times
Close liaison with Transport Providers
– eg meetings were arranged with the
Ambulance service and volunteer drivers
• Revised transport schedules produced
Tue3
Tue1
Tue1
Mon1
Tue3
Tue3
Mon2
Mon1
Mon2
Tue3Mon2
Tue1
Tue3
Mon2
Mon2
Mon2
Tue1
Tue1 Mon2
Mon3
Mon2
Tue1
Tue3
Tue1
Tue1
Mon1
Mon3
Tue1 Tue1
Mon2
Tue1
Tue1
Tue1
Mon1
Mon2
Mon3
Tue1
Tue2
Tue3
Tue3
Tue1
Tue3
Mon1
RESULTS
• Number of patients requiring transport
reduced from 51% to 34%
• 12 patients came off ambulance transport
• Number of journeys reduced by approx 33%
• Patient waiting times significantly reduced
RESULTS cont
• Patient complaints reduced
• Transport costs reduced
• Overall Service improvement
ANNUAL FIGURES
Before Changes
After Changes
No. on hospital transport
66
44
Taxi journeys
300-350 approx
0
Costs
Saving
£6,000
£0
£6000
Volunteer drivers journeys
3,000 approx
1,536
Costs
£13,350
(£4.45 per journey)
£6,830
Saving
£6520
Hospital Car Transport Journeys
11,500 approx
6,300
Costs
Saving
£86,250
(£7.50 per journey)
£47,250
£39,000
Ambulance (£8,892 per pt per year)
18
6
Costs
Savings
Total Saving
£160,056
£53,352
£106,704
£158,224
Southend Hospital Ambulance journeys for
dialysis patients
20
18
Number of patients travelling
by ambulance per month.
16
14
12
10
8
6
4
2
0
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
CONCLUSION
• Following a review of our entire transport arrangements,
significant improvements were made to all areas relating
to the transport experience.
• Our results showed that by grouping together patients
from the same area a reduction in the number of
journeys was apparent resulting in significant cost
savings.
•
22 patients came off hospital transport completely
• The new transport arrangements on-going.
RELEVANCE
• Good transport service plays a vital role in the formation
of patient views and attitudes towards dialysis, improving
patients’ experience and attendance.
• Significant cost saving-£158,224
• Better and more cost effective transport service
developed in line with recent Department of Health
recommendations.
• Enquiries from other Renal Units
NHS QIPP evidence website
(quality improvement productivity
and prevention)
NHS QIPP evidence
NHS QIPP evidence
Supporting the Quality, Innovation,
Productivity and Prevention (QIPP) agenda
What is QIPP?
The most important challenge facing the NHS is to deliver a
service with quality as its organising principle through a period of
significant financial challenge. Quality, Innovation, Productivity
and Prevention (QIPP) is the NHS response to this challenge – a
response that will be designed and delivered locally.
Reasons to get involved:
• The NHS must not lose its focus on quality because of the
economic challenges it faces
• Addressing inefficiencies to benefit patient care is the
responsibility of all in the NHS
• Trusts will become known as local, regional and national
beacons of best practice
• There is an urgent imperative to introduce better ways of
doing things
Small
change,
big
differenc
e
Will
the
case
studies
overleaf
inspire you
to make a
difference?
How does NHS Evidence support
the
Quality,
Innovation,
Productivity
and
Prevention
(QIPP) agenda?
NHS Evidence brings you evidencebased success stories. The QIPP
collection
showcases
practical
examples of how NHS organisations
are improving quality whilst making
efficiency savings. The collection will
provoke ideas and discussions about
how staff locally and nationally can
deliver ‘more for less’.
How do you access NHS Evidence?
Go to www.evidence.nhs.uk. You can
also download a version for mobile
phones so you can search for information
on the go.
Share your success
• NHS Evidence needs your help to build a comprehensive QIPP collection of best practice so we are
calling on all NHS organisations and all NHS Trusts to contribute examples of best practice to the QIPP
collection.
• Got something to smile about? If you’ve been involved in a successful QIPP initiative, why not share it
with your NHS colleagues? Visit the NHS Evidence website to find out how.
Beacons of best practice
Southend Hospital NHS Trust has
slashed its bill for dialysis transport
services by almost 60% after tailoring
transport to users’ individual needs. Users’
home addresses were mapped into closest
postcode districts and treatment times were
adjusted. Mobility of people using
ambulance transport was reassessed .
East Berkshire Community Hospital
End of Life Care Project
Rolled out in just 6 weeks, the pilot
project helped 20 staff from St Mark’s
and Upton Community Hospitals to
broaden their expertise during 1-week
secondments to Thames Hospicecare.
Before
During
After
£300,000
59%
£200,000
drop in dialysis
transport costs
£100,000
Step 1. Identifying
objectives
Project leaders
identified
individuals’
knowledge gaps
(such as managing
symptoms, holistic
assessment and
advanced care
planning)
Step 2.
Collaborative
mentoring
Step 3. Improving
community
practice
Secondees worked
with hospice team,
tracking progress
against core
competencies. Staff
identified changes
needed in
community hospital
Nurses learned the
importance of small
touches. New
practices include
sending condolence
cards with
bereavement
service information
”
£0
Before
After
Total annual dialysis transport costs were reduced from
£277,000 to £113,732. The most significant saving was
in ambulance costs, which were reduced from
£160,056 to £53,352 after reassessing eligibility. An
average PCT would save around £164,000 in the first
year so considerable savings could be made
nationwide.
“
Utilising community hospitals is a cost-effective option for
end of life care. After our secondment project, staff feel much
more confident in delivering this. I would strongly encourage
other organisations to submit their own examples for the
QIPP collection, so that we can all learn from each other.
Rosemary Martin, End of Life Service Manager
Berkshire East Community Health Services
”
NHS Kidney care
NHS Kidney care
National Cost savings.
• a saving in excess of
£25.5M for the NHS
in England
Happiness with transport
Proportion on hospital public or
private transport
Distance travelled to dialysis
RECOMMENDATIONS
• Strict control, monitoring and regular
updating of transport arrangements
• Regular patient assessment by
physiotherapists
• Regular meetings with volunteer drivers
and the ambulance service
Vote for Southend
• Established cost
savings
• Improvement in
quality
• Transferable process
• “Beacon of best
practice”
Vote for Southend
• Sustained effect on
quality and cost
Southend Hospital Ambulance journeys for
dialysis patients
20
18
• Improvement on good
practice
16
14
12
10
8
6
4
2
0
Jul-09
Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10
Jul-10
Aug-10
Vote for Southend
• Possible large scale
national savings
• £25,500,000+
• We will talk about it
again.
FIN