Improving patient outcomes and reducing healthcare costs

Impact

Dedicated modelling units in NHS Health Boards

We have established a Mathematical Modelling Unit within the Aneurin Bevan Continuous Improvement Unit (ABCi), additionally training NHS staff in how to apply OR models to develop and test alternative approaches to healthcare management.

In addition, Health Modelling Centre Cymru (hmc2) initiated the novel researchers-in-residence programme in partnership with NHS Wales, supporting both Aneurin Bevan and Cardiff and Vale University Health Boards, which collectively serve over 1.1 million people. This programme embedded modelling techniques within the improvement work undertaken at the health boards and has helped to advise on capacity needs, reduce waiting times, contributed to the planning of a mobile emergency unit in Cardiff city centre and has also helped with the development of a text mining tool to analyse a backlog of more than half a million outpatient letters. Without the innovative application of mathematics, manual data entry would have been the result which is not only costly but also more prone to errors. In 2015, the collaboration between Cardiff research and NHS practice was recognised by the Times Higher Education Awards and received the award for ‘Outstanding Contribution to Innovation and Technology.’ More recently, in 2021 the collaboration was awarded with the OR Society’s Lyn Thomas impact medal.

Improved design and operation of hospitals

ABCi approached our researchers in the School of Mathematics in 2016 requesting mathematical modelling support in the early-stage design of a proposed new hospital near Cwmbran, South Wales, which would serve a population of over 600,000. Design patterns developed in the E-HOSPITAL framework were used to assess the potential capacity and required capabilities of the hospital and optimise the flow of patients, reduce unnecessary surgical cancellations, reduce waiting times, and plan for safe care.

The proposed design, including our researcher’s recommended structural changes, became the confirmed plans for the Grange University Hospital, a new 470-bed hospital supported by a £350M investment from Welsh Government. The hospital opened ahead of schedule on 17 November 2020 to assist the South Wales response to both Covid-19 and winter health pressures.

Our modelling was praised not only for the improved efficiency in financial costs but also for maintaining the proposed level of service to the local population despite the reduced number of operating theatres.

Our team also applied mathematical programming techniques to identify cost savings and to run a more environmentally friendly mix of endoscopes in the University Hospital Munich. The platform was able to determine the optimal mix and inventory of disposable and reusable bronchoscopy devices, substantially reducing the need for single-use disposable bronchoscopy devices. CO2 emissions have also been reduced drastically together with a significant cost saving.

Supporting mental health outreach teams

Our research has supported the provision of mental health services across South Wales, focussing on Assertive Outreach Teams (AOTs). AOTs are a novel patient-led service which enable mental health professionals to identify and more readily respond to the needs of severely mentally ill adults, placing them on an appropriate care pathway to avoid progression of the patient’s condition to the point of hospitalisation. At Aneurin Bevan University Health Board, however, AOTs were perceived as a costly service with poorly understood benefits; these were due to be cut.

Modelling and statistical analysis work from our researchers quantified the benefits achieved by AOTs, which supported the business case made to the health board to continue to fund these teams. Our team developed a caseload management tool, incorporating clinical, demographic and staffing variables, such as medical history, specific patient needs, staff skill- mix, resource levels and availability, and geospatial demand and travel times, this enabled AOTs to better coordinate complex caseloads.

Further benefits for patients and the health board include:

• Improved patient outcomes measured by a reduction in the Adult Camberwell Assessment of Need (CANSAS) per patient by an average of 51%. The CANSAS measures severe needs for mentally ill adults across a range of physiological and psychological factors, such as psychological distress, self-care, and physical heath.
• A reduction in ineffective and unnecessary acute hospital admissions by 79%.Acute admissions are those which require diagnostic tests, treatment, and follow-up care.
• A 65% reduction in time taken off work by patients due to severe mental health episodes.

Reducing pressure ulcers

Pressure ulcers, which can occur when patients spend significant time in bed, are painful, impair mobility, and diminish a patient’s quality of life. Low staff morale has been identified as causing lapses in care, leading in increased instances of pressure ulcers (among other unintended consequences), which then further decreases staff morale, generating a negative feedback loop. Pressure ulcers are also costly to health boards; for example, pressure ulcers cost Aneurin Bevan University Health Board more than £500,000 per annum in compensation to affected patients.

We addressed this problem by developing a comprehensive simulation (system dynamics) model of the health board’s Unscheduled Care (USC) system. This modelled staff wellbeing and its impact on clinical performance and identified that current measures being implemented by the Trust would not be sufficient to reduce health acquired pressure ulcer incidences at the Royal Gwent Hospital.

To address these problems our researchers used the model to:

• Identify negative feedback loops
• Run joint learning sessions to help Unscheduled Care Staff to understand the complex dynamics of the health system
• Develop monitoring tools with a Clinical Psychologist to track staff wellbeing

These interventions helped prevent negative feedback loops occurring and transformed patient care from potentially harmful to safe. As a result, within two years, up to ten frontline teams prevented (at least) 265 pressure ulcers and averted more than £1.5 million in cost while securing better quality of care for patients and improved patient experience. The approach won the NHS Wales Award 2019 in the category Improving Patient Safety.