title: A cost-benefit analysis of twice-daily consultant ward rounds and clinical input on investigation and pharmacy costs in a major teaching hospital in the UK.
abstract: OBJECTIVE
  Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit.
  
  
  METHODS
  The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments.
  
  
  METHODS
  The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards.
  
  
  METHODS
  We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention.
  
  
  RESULTS
  Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention.
  
  
  CONCLUSIONS
  Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period.
authors: Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.
authors: Aftab
authors: A
authors: Ahmad
authors: Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.
authors: Philip J
authors: PJ
authors: Weston
authors: Department of General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.
authors: Mahin
authors: M
authors: Ahmad
authors: Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.
authors: Dushyant
authors: D
authors: Sharma
authors: Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.
authors: Tejpal
authors: T
authors: Purewal
mesh_terms: D000328:Adult; D003253:Consultants; D003362:Cost-Benefit Analysis; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D010607:Pharmacy Service, Hospital / Q000191:economics*; D056164:Teaching Rounds / Q000191:economics
keywords: Cost-benefit; Decision making; Inappropriate investigations; Quality iimprovement; Ward rounds