Optimisation of hospital resource use: A rapid review of the literature

Abstract

Project System Wide Integration for Transformation (SWIFT) is a programme of work supported by developments in technology that aims to improve the health of people in Counties Manukau through initiatives focused on community-based care and improving hospital systems. A “rapid review” of literature focussing optimisation of resource use in hospitals was carried out to support this programme. In total, 36 articles were considered in detail for inclusion in this rapid review, with many other articles considered briefly from title or abstract alone. Of the 36 articles, 24 (66.7%) were ultimately deemed relevant, and included. The review found reasonable evidence that patient length of stay can be reduced by using: (1) collaborative physician/nurse multidisciplinary care management of medical patients with expedited discharge, and assessment following discharge; (2) perioperative anaesthetic and pain management strategies for primary total hip (THA) and total knee arthroplasty (TKA); (3) the use of specialist nurses across a variety of roles, and team midwives who provide care for pregnant women from the beginning of care to the end of the post-natal period. It also found that there is potential for a reduction in adverse cardiac outcomes in hospitals through: (1) prescribing guideline discharge therapies in acute cardiac care, and (2) remote management of heart failure patients implanted with cardioverter defibrillators. The review also suggested that appointment cancellations or instances of non-attendance can be reduced by: (1) the establishment of pre-operative assessment and consultation clinics; (2) distributed access to scheduling systems; (3) preferentially loading appointments onto high-attendance days; and (4) the use of text messaging or automated phone calls to remind patients about appointments.