INTRODUCTION
Health services must always look to work as efficiently as possible. Any suggested changes to clinical practice should aim to either improve outcomes for patients or to reduce financial and human resource use whilst maintaining outcomes for patients.1, 2 The Getting It Right First Time (GIRFT) programme was set up in 2012 to minimise unwarranted variation in service provision and patient outcomes in the National Health Service (NHS) in England. The overall aim is to increase efficiency while maintaining good outcomes and experience for patients.
Unwarranted variation can be defined as any variation clinical practice which impacts on outcomes for patients which cannot be justified on the grounds of patient need, patient preference, equivocal evidence or intractable resource limitation.3 Examples of causes of unwarranted variation include clinician preference for a particular intervention, a lack of engagement with recent evidence, a lack of training in new techniques and poor resource allocation.3
The GIRFT methodology is based on engagement with clinicians by peers. During initial ’deep dive’ visits to each health service provider (NHS Trust), practice and patient outcomes for the provider are reviewed relative to other providers and the data discussed in the context of local resource constraints, service organisation and the population served. Providers demonstrating good patient outcomes or efficient resource use are discussed as possible models for those with poorer outcomes or resource use. Key recommendations are fed back to providers with support for implementation of service improvement.
The GIRFT national report for urology was published in July 2018 and summarised the key findings for the programme.4 The report identified a number of areas where there appeared to be unwarranted variation in clinical practice across providers that impacted negatively on patient outcomes or cost-effectiveness and made a number of recommendations of ways to reduce such variation. These included: 1) increased use of day-case surgery for transurethral resection for bladder tumour (TURBT), 2) reduced use of ureteric stents as the primary intervention for emergency presentations with ureteric stones and 3) reduced waiting times to male bladder outflow obstruction surgery, for example transurethral resection of the prostate (TURP), from first emergency admission with urinary retention.
The aim of this study was to investigate the impact of the GIRFT programme on these three areas of practice. In the longer term it was hoped that this may lead to the identification of barriers and facilitators to implementation. We used interrupted time-series analysis (ITSA) to analysis data from the period before and after visits to each NHS trust by the GIRFT team with the recommendations.
METHODS