Box 1.

Case study 1: estimating financial and carbon impacts of a primary care-based QI project

A primary care team noticed some of their patients referred for hip and knee replacements were being referred back to the GP surgery after preoperative assessment at the local hospital because preoperative parameters, eg blood pressure, were either outside the target range or not communicated properly in the referral information. An audit of practice referrals revealed that one in six patients ‘looped’ through the system. In a typical year this would result in around 10 unnecessary referrals for one large practice.
The team implemented a quality improvement project to improve communication between the surgery and local hospital team by creating a new preop consultation template for use by the GPs and including the completed template with referrals. The goal was to reduce looping within the system and the attendant waste of resources.
Measuring impact: a typical ‘waste loop’ could result in an extra GP consultation and an extra hospital consultation. Using published data, standard values for both financial cost and carbon footprint were attached to each activity, in order to calculate the resources saved for every loop prevented:
Costs of extra GP consultation: £45,11 18 kg CO2e12
Costs of hospital consultation: £112,11 23 kg CO2e12
Total financial and environmental savings for 10 referral loops avoided: £1,570, 410 kg CO2e
Estimated value impact of project over 1 year
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