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PLASMA+ Increased Day Case Rates, Released Inpatient Bed Capacity, Reduced Readmission Rates, and Improved Patient Experience in Value Based Procurement Pilot

20 September 2024

870

inpatient bed days released

£230,000*

total savings combined

7%**

combined reduction in readmission rates

Executive Summary

  • Reduced hospital stay: The average length of hospital stays decreased by 1.8 days for enlarged prostate procedures and 1 day for NMIBC procedures
  • Increased bed availability: 870 inpatient bed days were released from April 2021 to March 2022
  • *Cost savings:
    • Enlarged prostate procedures: £152,000 total savings (£485 per patient)
    • NMIBC procedures: £78,000 total savings (£243 per patient)
  • **Lower readmission rates:
    • Prostate treatment readmission rates dropped from 7% to 2%
    • NMIBC procedures readmission rates fell from 4% to 2%.

The Challenge

Cheltenham General Hospital is a large NHS district general hospital under Gloucestershire Hospitals NHS Foundation Trust, has 960 beds and employs around 8,000 people.

The hospital faced a challenge in meeting the NHS referral-to-treatment (RTT) standard target to provide treatment to 92% of patients waiting for elective treatment within 18 weeks of referral. With only 68% of urology patients treated within this timeframe in March 2019 1, the hospital set ambitious goals to increase day case rates and reduce readmissions.2

At the time, the hospital offered two main surgical treatments: monopolar transurethral resection of the prostate (mTURP) for urinary issues caused by enlarged prostates, and monopolar transurethral resection of bladder tumour (mTURBT) for patients with suspected non-muscle invasive bladder cancer (NMIBC).

Between April 2018 and March 2019, the hospital performed 290 mTURP procedures, with an average length of stay of 2.2 days. Only 2% of these procedures were conducted as day case surgeries, with a readmission rate of 7% 3.

During the same period, the hospital performed 282 mTURBT procedures, with an average length of stay of 1.3 days. Of these, 15% were performed as day case surgeries, also with a readmission rate of 7%.

PLASMA+ Campaign image

The Aim

TURP and TURBT are procedures that, if performed routinely as day case surgeries, could help free up much needed inpatient bed capacity. This pilot aimed to:

  • Increase day case rates
  • Release inpatient bed capacity
  • Reduce readmission rates
  • Improve patient experience.

The Solution

The hospital introduced a new day case pathway for those patients who were eligible to receive treatment and go home on the same day, replacing the existing inpatient pathway where patients routinely required admission for one or more nights.

Moving from an inpatient to a day case pathway requires clear expectations for staff and patients, ideally overseen in a dedicated day case unit.

As part of this new day case pathway, the hospital introduced PLASMA+, a bipolar resection device from Olympus, replacing the incumbent monopolar device used to treat enlarged prostates and NMIBC.

Olympus PLASMA+, which has received a recommendation from the National Institute for Health and Care Excellence (NICE) and is covered by the MedTech Funding Mandate, uses an electrode to remove benign prostate tissue and NMIBC 4 -5.

The Process

This value based procurement pilot compares the length of stay, day case rates, and readmission rates before and after introducing a day case pathway which includes Olympus’ PLASMA+, replacing the previous inpatient pathway and monopolar device and evaluates the impact on resource costs per patient.

The Results

Plasma+ Equipment

Between November 2021 and October 2022, the urology unit at Cheltenham General Hospital performed 313 procedures to treat enlarged prostates and 320 procedures to treat NMIBC, all using PLASMA+6.

Introducing a day case pathway, including PLASMA+, replacing the inpatient pathway and previous monopolar device led to a notable 7 reduction in the average length of hospital stays—1.8 days fewer for enlarged prostate 8 procedures and 1 day fewer for NMIBC procedures. As a result, 870 inpatient bed days were released from April 2021 to March 2022, generating significant resource cost savings: approximately £152,000 for enlarged prostate procedures (a £485 resource cost saving per patient) and £78,000 (a £243 resource cost saving per patient) for NMIBC procedures.

Replacing the previous inpatient pathway and monopolar device with a day case pathway, which included PLASMA+, led value additionally, the readmission rates fell from 7% to 2% for those receiving prostate treatment, and to 4% for NMIBC procedures when comparing the periods of April 2018 to March 2019 with November 2021 to October 2022 3-6.

Financial Benefits

Overall, the hospital achieved a total annual resource cost saving of £230,000 between November 2021 to October 2022, demonstrating the impact of introducing a day case pathway – of which PLASMA+ was a part of- on this hospital’s efficiency and patient care.

Pathway

Before

One-stop clinic

Waiting list

Pre-operative period

Operation day

1.3 to 2.2 days stay in hospital

TWOC clinic

Discharge

After

One-stop clinic

Waiting list

Pre-operative period

Operation day

0.3 to 0.4 days stay in hospital

Discharge

TWOC clinic

Operational Benefits

In addition to the financial benefits, Cheltenham General Hospital also realised the following operational benefits:

  • Delivery of care moved from inpatient to day case, reducing pressure on inpatient beds.
  • Improved surgical waiting times by treating more patients per list; the hospital now routinely performs 8-9 PLASMA+ (prostate) cases during a dedicated Saturday list.
  • Increased theatre efficiency, by treating more patients per list.
  • Maximised the use of day case pathways, aligning with a key aim of Getting it Right First Time (GIRFT) and the British Association of Day Surgery (BADS).
  • Harmonisation of electrosurgical generators across theatres, reducing cost through technology investment and standardising procedures and usability across departments.

Further Opportunities

Using Olympus’ PLASMA+, as a part of a day case pathway can help realise the benefits and, according to a recent study, may also contribute to meeting the net-zero target for carbon emissions through the increased use of day case pathways 9.

Next steps

Olympus has created a step-by-step ‘how to’ guide for those considering day case pathways for TURP and TURBT.

See our Useful Links section if you would like a copy of the ‘how to’ guide that Olympus developed in collaboration with Consultant Urologist Helena Burden from North Bristol NHS Trust. The guide integrates the use of PLASMA+, a NICE-recommended technology for treating enlarged prostates, also recognised in the 2022 / 2023 MedTech Funding Mandate Policy 4-5.

For support regarding the implementation of the MedTech Funding Mandate, please get in touch with your local Health Innovation Network (HIN) or NHS England and NHS Improvement’s Innovation Team via nhsinnovationservice@innovation.nhs.uk

References

  1. The King’s Fund. (n.d.). Waiting times for elective (non-urgent) treatment: referral to treatment. [online] Available at: https://www.kingsfund.org.uk.
  2. This statistic refers to all patients in the urology department, not just those waiting for mTURP or mTURBT procedures.
  3. Getting It Right First Time (GIRFT). (2024). National Consultant Information Programme (NCIP). GIRFT. Retrieved January 23, 2023, from https://nhsi.okta-emea.com/.
  4. www.nice.org.uk. (n.d.). Overview | The PLASMA system for transurethral resection and haemostasis of the prostate | Guidance | NICE. [online] Available at: https://www.nice.org.uk/guidance/mtg53.
  5. www.england.nhs.uk. (n.d.). NHS Accelerated Access Collaborative» MedTech Funding Mandate and MedTech Support. [online] Available at: https://www.england.nhs.uk/aac/what-we-do/how-can-the-aac-help-me/the-medtech-funding-mandate/#supported-tech-24-25 [Accessed 29 Feb. 2024].
  6. NHS England. (2024). The Model Health System. Retrieved January 23, 2023, from https://model.nhs.uk/.
  7. The average length of stay decreased from 2.2 days (April 2018 to March 2019) to 0.4 days (November 2021 to October 2022), a reduction of 1.8 days, after transitioning from an inpatient to a day-case pathway and replacing mTURP with PLASMA+.
  8. The average length of stay decreased from 1.3 days (April 2018 to March 2019) to 0.3 days (November 2021 to October 2022), a reduction of 1 day, after transitioning from an inpatient to a day-case pathway and replacing mTURBT with PLASMA+.
  9. Phull, M., Begum, H., John, J.B., van Hove, M., McGrath, J., O’Flynn, K., Briggs, T.W.R. and Gray, W.K. (2023). Potential Carbon Savings with Day Case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data. European Urology Open Science, [online] 52, pp.44–50. Doi https://doi.org/10.1016/j.euros.2023.03.007.