SERVICE ORGANISATION- section Title: National initiative in England to reduce unwarranted variation: Getting in Right First Time (GIRFT) – Stroke Program. Background and aims: Reducing unwarranted variation is vital if centrally (taxation) funded health care is to remain affordable. Estimates in England suggest savings of >£5 billion (4%), of which £2billion are in workforce efficiency. The GIRFT stroke program is a clinically led NHS Improvement program using process markers of care, along with outcome data including recurrence rates and costs, with patient reported outcomes to reduce unwarranted variation and support networked quality improvement. Method: Using existing process markers of care (SSNAP) with Hospital Episode coded activity (HES), Diagnostic imaging data (DIDs), observed mortality data (ONS) and patient reported outcome measures (PROM's) a geographic representation of variation of care will be formed. Regional workshops supporting individual hospital teams with ‘deep dives’ will highlight variation, celebrating excellence and providing networked support for improvement. 122 acute stroke provider organisations in England will have individualised data with clinically lead focused discussions grouped geographically in 2019. Results: 20 hospitals have had pilot visits over 2 regions in 2018 >12,000 patient episodes. 7% variation in adjusted mortality 14 day variation in length of hospital stay 4% variation in stroke recurrence rate at 1year 10% variation in need for antibiotics in first 7 days post stroke 12% variation in IV thrombolysis rate 80% variation in timely SLT assessment 30% variance in use of MRI scanning £200 variance in one bed day care costs Conclusion: Significant variation exists between pilot sites with in the same region. Through delivering networked improvement methodology a reduction in unwarranted variation and improved efficiency is envisaged.
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