Viewpoint: Cut out waste

Performing the right test at the right time saves costly resources, says Daniel Maughan.

The Academy of Medical Royal Colleges has published a report on the wasteful use of clinical resources. Most people think of waste in a product sense (such as excess packaging or rubbish), but in the NHS most waste springs from clinical practice.

Investigations, medications and hospital beds are clinical resources that can be wasted if not used appropriately to maximise value for patients.

The Protecting resources report, which I co-wrote, states: ‘If the finite NHS resources are spent on costly interventions that have little benefit, then the service we provide will be of little value and the resources we have will be wasted.’

We argue that minimising wasted resource has a triple imperative; it improves the value of care, cuts costs and reduces the environmental impacts of care.

When making decisions, patient benefit and patient preference needs to be balanced against patient harm and resource usage. Chasing after minimal patient benefit while spending ever-increasing amounts of clinical resource increases the chances of patient harm. Performing the right test or procedure at the right time is fundamental to reducing waste in clinical decisions.

The report shows how waste can be reduced if educational reminders are sent following requests for X-rays. Guidance notes have been provided alongside the report of every relevant radiograph. The number of referrals for both knee and lumbar spine radiographs fell by 20 per cent and remained consistently lower over a one-year period.

An initiative called Choosing wisely will be launched in due course by the academy in response to the realisation that many interventions may be unnecessary or harmful.

This was initially launched in the US. In the UK, healthcare organisations, such as the CSP, will be invited to identify tests or procedures that are commonly used in their specialty that might not be needed.

Daniel Maughan is a Royal College of Psychiatrists sustainability fellow, Centre for Sustainable Healthcare



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