Value Based Procurement Pilot Reduces Length of Stay and Improves Patient Experience
The introduction of the elastomeric device at Oxford University Hospitals NHS Foundation Trust has offered patients needing certain intravenous antibiotics a viable alternative to staying in hospital. It has been well received by patients and clinicians, as it has contributed towards our antimicrobial stewardship by optimising the antimicrobials we are able to deliver at home.Sophie McGlen – Antimicrobial Pharmacist (AHAH/OPAT Team)
Oxford University Hospitals (OUH) is a world-renowned centre of clinical excellence and one of the largest NHS teaching trusts in the UK, employing over 14,000 staff and has 1,059 beds. It is made up of four hospitals – the John Radcliffe Hospital, the Churchill Hospital and the Nuffield Orthopaedic Centre, all located in Oxford, and the Horton General Hospital in Banbury, north Oxfordshire. OUH provide a wide range of clinical services, specialist services (including cardiac, cancer, musculoskeletal and neurological rehabilitation) medical education, training and research.
Intravenous (IV) antibiotic therapy is regularly given for a wide variety of moderate to severe infections. This is often given as a bolus in hospitals on a 4-hourly basis. Working with the clinical and procurement teams at Oxford University Hospitals NHS Foundation Trust (FT), Vygon UK successfully piloted fresh fill elastomeric pumps as a means of enabling selected patients to receive IV antibiotics at home. This can facilitate earlier discharge and prevent hospital admissions by enabling the patient to be treated at home with a once daily home visit by the Acute Hospital at Home (AHAH) nursing team.
The use of elastomeric pumps for intravenous antibiotics is an alternative delivery method for patients. Depending on the therapy needed, these medications might include antibiotics, chemotherapy, 5FU, cytostatics, analgesics, and local anaesthetics. This case study looks at the use of fresh filled pumps to enable patients who are otherwise stable to continue their antibiotic treatment at home. The aim of this Value Based Procurement pilot was to promote the use of an elastomeric pump for IV therapy to:
- Reduce the patient length of stay, enabling them to receive IV antibiotics at home.
- Deliver savings due to bed days released.
- To promote antimicrobial stewardship.
The Vygon UK Accufuser® elastomeric pump is a safe, single use, medical infuser that enables continuous infusion of a set volume of medication within a set time period. The stable elasticity and flow through the silicon container ensures the correct amount of medicine is administered. The device can be attached to a central venous access device (CVAD) and peripheral IV lines , no additional electronic devices or tools are required.
The device is convenient, easy to carry, and does not restrict daily activities. The continued training and support for the clinical teams is key to success, Vygon UK’s partnership with OUH ensured that all barriers were discussed and overcome to meet the desired outcomes.
The current process for treating patients with IV antibiotics (primarily flucloxacillin and pip-taz) requires patients to be admitted to hospital in order to receive 3-4 time per day infusions; depending on the nature of the infection, this can mean a 7-14 day course of treatment.
In some cases, a broad-spectrum antibiotic is used to provide a once per day infusion for efficiency however, this promotes antibiotic resistance.
Vygon UK proposed a new fresh fill model whereby an Accufuser® elastomeric pump was filled with the specific antibiotic on site so that eligible patients could start their infusion and be discharged from hospital in the care of the AHAH team. This released the prospective bed days, promoted antimicrobial stewardship and increased patient satisfaction.
During December 2019 to September 2021, 86 patients were discharged with the device with a total of 1,143 bed days released, equating to cost savings of £360,410 (OUH net saving).
Feedback sought from patients during the pilot has been very positive. Most patients found the device to be comfortable and it did not restrict their daily activities. Most patients surveyed said they would use the device again.
The Oxford Academic Health Science Network (Oxford AHSN) worked with Oxford University Hospitals NHS FT to understand the benefits of introducing the elastomeric device into clinical practice, both for patients and the hospital. Clear benefits were demonstrated as medically stable patients were able to be discharged earlier to continue their IV antibiotic treatment at home, thereby reducing pressure on beds, improving the patient flow through the hospital and providing a good experience for patients.Alison Gowdy, Clinical Innovation Adoption Manager, Oxford AHSN
Based on the plan to manage 200 patients per annum at home with elastomeric devices, there is the potential to release 2,000 bed days per annum. This is based on an average of each patient receiving 10 days of IV antibiotic treatment at home.
The financial benefit of releasing 2,000 bed days, based on OUH net saving of £315.32 per patient per day, would equate to a notional financial benefit of £630,640. Overall net savings may vary by trust.
The introduction of the fresh fill elastomeric device at the trust has, to date, enabled 86 clinically eligible patients to be discharged home to continue to receive their IV antibiotic treatment. By facilitating earlier discharge, the pressure on inpatient beds has been reduced and will have helped to manage demand for inpatient beds more effectively.
The efficiency of the AHAH team has also increased, as a greater number of patients can now be managed due to fewer home visits being required. Some patients are medically stable and only in hospital for IV antibiotic administration, utilising an inpatient bed which could be released if the infrastructure was in place to deliver treatment via elastomeric devices in patients’ homes. A review of the trust’s data suggested 200 – 250 patients per annum who were receiving IV antibiotics as an inpatient could potentially benefit from earlier discharge with the elastomeric device.
An additional benefit, unrelated to reducing length of stay, was the use of the elastomeric device to help with the response to COVID-19. The device was used with a number of COVID-19 positive inpatients as a means of reducing close contact between patient and nursing staff.
This form of technology would present a significant opportunity for wider introduction at scale at an STP/ICS level, which would fully optimise the potential for providing care at home and releasing capacity at a regional level.
The procurement team are increasingly focussed on working with our suppliers to develop projects that not only deliver commercial benefits for the trust, but also provide significant efficiency improvements and have a direct impact on improving patient care.Conor Allmond, Procurement Business Partner MRC Division, Oxford University Hospitals NHS FT
For further information relating to this pilot, or access to the cost benefit calculator, please contact
This case study was carried out at Oxford University Hospital FT in conjunction with Vygon (UK) Ltd. There may be other comparable solutions within the market that are suitable in addressing the challenges highlighted in this report.