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