Enhancing patient experience and flow – day case BPH pathway improvements at Liverpool University Hospitals

This case study showcases best practice in BPH pathway transformation, using a real‑world example to illustrate how minimally invasive day‑case care can improve outcomes and system efficiency.

Urology services at Liverpool University Hospitals were facing increasing capacity pressures, alongside the need to improve productivity without compromising patient outcomes.

Traditional inpatient BPH procedures such as transurethral resection of the prostate (TURP):

• Required longer theatre time and inpatient stays.
• Longer stays contributed to delays, bed pressures and reduced flexibility within elective pathways.

The trust wanted to explore whether a lower‑acuity, day‑case approach could improve patient flow while maintaining clinical quality.

The trust undertook an options appraisal to compare the existing inpatient pathway with a minimally invasive, day‑case BPH approach. We have supported this work by providing localised economic and pathway modelling, using trust‑specific assumptions for staffing, consumables, theatre time and bed day costs.

The modelling assessed the impact of each pathway on:

• Length of stay and recovery time
• Theatre and anaesthetic requirements
• Staffing mix and resource use
• Patient experience and mobilisation
• Scheduling flexibility and throughput.

While this case study is based on one such technology (Rezūm™), NHS Supply Chain offers a range of clinically validated minimally invasive BPH options through its frameworks, enabling trusts to consider the approach that best fits their local needs.

The modelling demonstrated that adopting a minimally invasive, day‑case BPH pathway could deliver significant benefits across patient experience, efficiency and productivity.

Key outcomes included:

Shorter recovery and improved flow

Recovery time reduced from 48 hours to approximately five hours, freeing up 43 bed hours per patient and enabling faster discharge.

Reduced theatre and anaesthetic time

Surgical time reduced from 1 hour to 0.33 hours, with anaesthetic time reduced from 0.33 hours to 0.17 hours, improving scheduling flexibility and reducing staffing demand.

True day‑case delivery

Same‑day discharge eliminated the need for overnight admission, reducing inpatient bed use and supporting quicker mobilisation.

Efficiency and capacity gains

For a cohort of 50 patients per year, the trust could release:

• 125 bed days
• 100 clinical hours.

Financial impact

The modelling demonstrated a net efficiency and productivity benefit of £1,413.91 per patient, equating to £70,695.50 per annum for a cohort of 50 patients.

This value is driven by a combination of reduced length of stay, lower theatre and anaesthetic time, elimination of overnight admission, and improved pathway efficiency and capacity utilisation.

Alongside the financial benefits, the pathway supported a safer, less invasive patient experience with reduced procedural burden.

*The analysis is based on trust‑specific modelling of staffing, consumables, theatre time and bed day costs.

This work was developed in close collaboration with the Liverpool Innovation Team and clinical leadership, providing strong system‑level endorsement.

Increased efficiency has significantly reduced waiting lists, enabling the team to treat more patients than before. Working with NHS Supply Chain helped us understand the wider system benefits of moving BPH care into a minimally invasive, lower‑acuity setting.

Mr Matthew Liew, Consultant Urological Surgeon, Liverpool University Hospitals

This work clearly demonstrates how value‑based procurement can deliver meaningful productivity and efficiency benefits, alongside improved patient experience.

Dr Andrew Rose, Assistant Director of Innovation, Liverpool University Hospitals

This case study illustrates how a value‑based, pathway‑led approach to BPH care can support elective recovery and service sustainability.

Our teams will support trusts and ICSs with:

• Supplier‑neutral pathway analysis
• Localised clinical and economic modelling
• Framework access to clinically validated technologies
• Support for adoption and implementation.