David introduced a consultant led a ‘Fit to Admit’ clinic 2003 – this is an extrapolation of the principles of a service that is to front load the service with experts i.e. the consultant. This was a cost neutral change that has enhanced the patient experience and improved that patient pathway. It has also delighted all the staff.
The benefits of the clinic have really come into their own as we are able to admit cardiac patients on the same day for surgery mitigating the lack of beds. We even offer a taxi service to assist same day admission. Despite the increasing complexity and co-morbidities of the patients over this period of time (percentage of patients with EuroSCORE >5 increasing from 20% to >40%) 25.3% patients are discharged on the evening of day 4 and 62.2% are discharged at by Day 6. The saving in bed days has exceeded 2200. This process is realising over £140 000.00 in savings every year. He was shortlisted for a National QUIPP award in 2012.
The fit to admit process enables a flexible and responsive service mitigating cancellations. An unnecessary admission has been avoided in over 100 cases. Patients are welcome to challenge the need for surgery and some have even felt able to change their minds. It is “what matters to you” that is important!