Re-evaluating the National Subarachnoid Haemorrhage study (2006) from a Patient-Related-Outcome-Measure perspective: comparing fiscal outcomes of Treatment-as-Usual with an enhanced service

Abstract

Background. Subarachnoid haemorrhage (SAH) is neurological catastrophe, creating major disruption for patient and family, hence the importance of considering Patient-Related-Outcome-Measures (PROM). This study uses the National Study of SAH (2006) to explore any fiscal benefits to patients and NHS if they had an enhanced Neuro-Vascular-Specialist-Nurse (NVSN) service compared to Treatment-as-Usual (TAU).

Method. Ensuring total confidentiality, clinical data from the National Study (n = 2397) were matched with regional clinical data of a TAU (n = 137) and prospective NVSN service (n = 184) patients. The TAU and NVSN fiscal outcomes were projected onto the National Study patients to provide estimates of the potential benefits that could accrue nationally from a NVSN service based upon length of stay and earlier return to work of patients and carers.

Results. There were substantial benefits for NVSN cohort related to shorter time in hospital, reduced family disruption, earlier return to work and fiscal benefits to family and the NHS. NVSN patients and carers potential savings were estimated at £8.097 million and £2.492 million to the service, £10.497 million overall.

Practice implications. This PROM approach allows the ‘patient's voice’ to be heard, which facilitates speedier patient and family recovery, showing that an integrated treatment approach in ‘high tech’ neuro-surgery is cost-effective.

Key words:

• Subarachnoid haemorrhage
• neurorehabilitation
• carers
• specialist nurse

Acknowledgements

It is recognised that the study could not have proceeded without the active work and collaboration of a number of colleagues including Neurosurgical Consultants Jonathan Duffil, Dorothy Lang, Glen Neil-Dwyer, Owen Sparrow, and Sister Beryl Pritchard all of the Wessex Regional Neurological Unit; to Professor John Pickard, University of Cambridge and Dr. Langham of the Health Improvement Unit at the RCS but most of all to the patients and carers who gave of their time in contributing to the original questionnaires and to all former patients and their carers who completed them. Finally authors are deeply indebted to the Southern General Hospital Neurovascular Fund for contributing to the financial costs of this project.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.