There is huge variation in some of the processes and outcomes of treatment between NHS hospitals in England – anything from your chance of being discharged quickly (varies by a factor of more than 2) to the chance of not going back home and going permanently into care following an emergency admission. This may be despite similar services or interface structures. Why is this, and what can we learn from this variation?
We have never been short of data – the challenge is how to use it
GIRFT (Getting It Right First Time) is an NHS England programme which combines data analysis to identify variation between hospitals and providers (good and bad) with visits. These visits are led by clinicians (me in the case of Geriatric Medicine), along with a GIRFT Project Manager, with follow up support by the GIRFT Implementation Managers, focusing on agreed actions from the visit. GIRFT has hubs in each region of NHS England – 7 in total. We start by creating a data pack using the Trust's data and we plan to pilot this at three Hospital Trusts in November. When these have been completed successfully we will have an agreed common datapack for all Hospital Trusts and they will all receive an email announcing the start of the visits. I will be on the road coming to all Geriatric Medicine providers in England – so watch out for me in a state of disorientation!
GIRFT started as a programme in Orthopaedic Surgery, following which we have already seen improvements in litigation costs (where there was huge variation), post-operative wound infection rates, and procurement costs of joint replacement prostheses. It now covers most surgical specialities, and from early 2018 has started to include medical specialities, including Geriatric Medicine. Currently there are 37 GIRFT specialities, including pilots in primary care and some early work on mental health.
GIRFT doesn’t just have a hospital specialty focus but also has some cross-cutting themes. One of these is frailty, which I am leading. We will have a view of frailty within a hospital beyond our speciality, identifying patients by age but also using ICD codes which identify frailty. We plan to have a wider system view of frailty which will include care homes. However, there are challenges in both data quality and information governance which limit what we can do.
Data is never perfect and we have some great analysts to do the work and then chart it, but we are very dependent on data from hospital admissions which is only a partial view. We are working jointly with NHS benchmarking and Right Care and you may have contributed to the recent benchmarking review of acute frailty care which will be one of our most important themes.
If you would like to be the contact for your Trust’s Geriatric Medicine deep dive, please contact Caroline Ager c [dot] ager [at] nhs [dot] net, Geriatric Medicine Project Manager, or should you have any general questions or suggestions on GIRFT, please contact Caroline.