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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
  1. Aftab Ahmad1,
  2. Philip J Weston1,
  3. Mahin Ahmad2,
  4. Dushyant Sharma1,
  5. Tejpal Purewal1
  1. 1Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK
  2. 2Department of General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK
  1. Correspondence to Dr Aftab Ahmad; aftab.ahmad{at}


Objectives 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.

Settings 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.

Participants and intervention 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.

Outcome measures 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.

  • Inappropriate investigations
  • Cost-benefit
  • Quality iimprovement
  • Decision making
  • Ward rounds

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