Choo, Teck, Deb, Shilpa, Wilkins, Joanne and Atiomo, William
(2014)
Evaluating the impact of the reconfiguration of gynaecology services at a University Hospital NHS trust in the United Kingdom.
BMC Health Services Research, 14
(428).
pp. 1-11.
ISSN 1472-6963
Full text not available from this repository.
Abstract
Background: The project aim was to investigate the impact of reconfiguring gynaecology services on the key
performance indicators of a University Hospital NHS Trust in the UK. The reconfiguration involved the centralisation
of elective gynaecology on one hospital site and emergency gynaecology on the other.
Methods: Data measuring outcomes of the Trust’s performance indicators (clinical outcomes, patient experience,
staff satisfaction, teaching/training, research/development and value for money) were collected. Two time periods,
12 months before and after the reconfiguration in March 2011, were compared for all outcome measures except
patient experience. Retrospective data from the hospitals audit department on clinical activity/outcomes and
emergency gynaecology patient’s feedback questionnaires were analysed. Staff satisfaction, teaching/training and
research/development were measured through an online survey of gynaecology consultants.
Results: Post reconfiguration, the total number of admissions reduced by 6% (6,867 vs 6,446). There was a 14%
increase in elective theatre sessions available (902.29 vs 1030.57) and an 84% increase in elective theatre sessions
cancelled (44.43 vs 81.71). However, the average number of elective operations performed during each theatre
session remained similar (2.63 vs 2.5). There was a significant increase in medical devices related clinical incidents
(2 vs 11). With patient experience, there was a significant reduction in patient’s overall length of stay on the
emergency gynaecology ward and waiting times for investigations. For staff satisfaction, Consultants were
significantly more dissatisfied with workload (3.45 vs 2.85) and standards of care (3.75 vs 2.93). With research and
development, consultants remained dissatisfied with time/funding/opportunities for research. No significant
impact on undergraduate/postgraduate teaching was found. No financial data on gynaecology was provided for
the assessment of value for money.
Conclusions: Reconfiguration of gynaecology services at this Trust may have resulted in a reduction in
gynaecological activity and increased cancellation of elective operations but did not significantly reduce the
number of elective operations performed. Although consultants expressed increased dissatisfaction with
standards of clinical care, clinical incident reports did not significantly increase apart from medical devices
incidents. Patient experience of emergency gynaecology services was improved. This manuscript provides a
framework for similar exercises evaluating the impact of service redesign in the NHS.
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