Better Care: Improving efficiency in hospitals by predicting demand

What we did

We carried out several pieces of work using existing local datasets for planned knee and hip replacement operations.

What we found and what this means

The impact of pausing planned hip and knee surgery during winter pressures

In the winter of 2017, the NHS paused planned hip and knee surgery for two months because of winter pressures. This created a ‘natural experiment’ where we could look at trends for these surgeries before and after the pause (between 2016 and 2019).

We found an immediate and sustained reduction in the number of knee replacements being done at the Trust following the pause. The average age for knee replacement increased after winter 2017, while the proportion of more deprived people having knee replacements decreased.

The ratio of public to private provision of hip and knee replacements dropped after winter 2017. This suggests an NHS-funded outsourcing of younger and less complex hip and knee replacement surgery to independent private providers.

The impact of restricted hip and knee surgery provision during the COVID-19 pandemic

The NHS suspended elective hip and knee replacement operations in April 2020 due to the COVID-19 pandemic. To understand the impact these restrictions had on the delivery of joint replacement surgery, we used data from one hospital to estimate the expected number of operations that could have taken place between January 2020 and June 2021. We compared this to the real number of operations that took place during that period.

We found that the number of hip and knee replacement procedures were lower than predicted. Approximately half of the expected number of operations were performed during the pandemic and the effect was greatest for revision knee replacements.

On average patients were also in hospital for one day less than they had been before the pandemic. They were also younger and had slightly more underlying health conditions than patients who were operated on before the pandemic.

Risk factors for extended hospital stays after knee replacement surgery

We looked at knee replacement surgeries that took place between 2016 and 2019 at one NHS Trust in England. During analysis we found that longer hospital stays were associated with:

• Being older
• Being female
• Coming from a deprived background
• Having additional health conditions

Staying in hospital despite being medically fit for discharge was associated with:

• Being older
• Being female
• Coming from a deprived background

The models we used to analyse this data could be used to identify which patients are likely to occupy hospital beds for longer. This could help hospitals schedule operations and improve efficiency.

Risk factors for extended hospital stays after hip replacement surgery

We looked at hip replacement surgeries that took place between 2016 and 2019 at one NHS Trust in England. During analysis we found that longer hospital stays were associated with:

• Being older
• Being female
• Having additional health conditions

Patients were also more likely to have a longer hospital stay or not be discharged despite being medically fit if they had recently been admitted to hospital (within last two months).

Staying in hospital despite being medically fit for discharge was associated with:

• Being older
• Being female
• Coming from a deprived background

What next?

Regulating patient flow through hospitals improves the working environment, reduces overcrowding and enables hospitals to provide better care for patients.

We will use this work to develop algorithms. These will help NHS trusts to better plan resources over a longer period. Understanding demand allows trusts to plan capacity, including beds, staffing levels and operating theatre time. This would help them to manage surges in demand and could lead to fewer cancelled operations.