Abstract

Purpose - Successive governments have called for greater "empowerment" of the patient, reflected in the chief medical officer's call for more patient-related outcome measures (PROM). This paper aims to bring together three-linked studies.Design/methodology/approach - First study: in 1999, the neurosurgical patient was seen as "expert" to identify PROM outcomes, based upon a patient and carer-designed self-administered postal questionnaire in a regional two-year retrospective survey of subarachnoid haemorrhage (SAH) patients with a 77 per cent response rate, designated treatment-as-usual (TAU) cohort (n = 142). Second study: in the same region, following the implementing of the specialist neuro-vascular nurse (SNVN), the SNVN recommendation was evaluated in a two-year prospective study (n = 184) that provided family-specific psychosocial support and a continuity of care linking hospital and community; the response rate was 87 per cent. Third study: A re-analysis of the national SAH study (n = 2,380), by projecting the TAU and SNVN results onto clinically matched patients within the National cohort to estimate the potential "savings" if all 34 neurosurgical units had an SNVN type service.Findings - First study: respondents identified many psychosocial and fiscal problems but recommended a SNVN to reduce these difficulties. Second study: the TAU and SNVN patient's were a close clinical match and using the TAU as a control group, it was found that there were major psychosocial and fiscal benefits for SNVN patients and carers, who more speedily re-established their lives. Third study: it was estimated that this would have produced major financial benefits, e.g. 4,165 fewer bed occupancy days, saving £2.5million; reduced time-off work for patients and carers, saving £8.1million; and, after deducting cost of a national SNVN service, a combined saving for the service and families of an estimated £9.83 million p.a. Thus, addressing PROM outcomes, through an integrated psychosocial service in neurosurgery was cost-effective, benefited families, the service, and the wider economy and should be a factor when considering pressurised departmental budgets.Originality/value - Overall, what the two regional studies and the re-analysis of the national study showed was that there are benefits from treating the "patient as expert" and taking on board their agendas. There is a need for a more integrated approach to treatment and care that is of value to the service, patients, families and the wider economy