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Our Utilisation Management Programme, directed by Aldwin Savery, is designed to ensure that resources are being used as efficiently as possible without compromising the quality of care provided to our patients.

Its focus is on both over-and under-utilisation of resources. Utilisation Management evaluates the patient's need for resources during the course of hospital stay, firstly by assuring the necessity of hospitalisation and then by facilitating effective case management.

This, in turn, assists with diagnostic and therapeutic services, facilitates discharge planning, supports physicians in addressing discharge delays and audits the patient's clinical record after discharge.

Monitoring the length of a patient's hospital stay (LOS) is another area being addressed with this programme. At present, KEMH's LOS is high when compared with hospitals of similar size in other jurisdictions. This has prompted the Bermuda Hospitals Board to implement a more structured Utilisation Programme under the leadership of Mr. Savery and his staff.

According to Mr. Savery, "The overall goal of the programme is to reduce the length of stay for specific disease processes without compromising quality at both facilities. This is best achieved by standardising care based on the best clinical practice.'' The Utilisation Management Committee is comprised of five physicians, including one psychiatrists, and representatives from Nursing, Management, Clinical Records, Finance, Community Services, Social Work and Quality Improvement.

The Committee has developed several tools which cut out unnecessary tests and procedures, standardise care and document information for quality improvement audits.

Clinical Practice Guidelines help caregivers and patients make decisions about appropriate health care. They include acceptable approaches to the prevention, diagnosis, treatment or management of a disease or condition.

Care Maps achieve better quality and cost outcomes by outlining usual and/or desired care.

Impact Analysis insures that effective use of resources begins during the planning process, before programmes are implemented within the hospital. It provides a valuable baseline for comparison to the actual type and volume of services provided.

The Bermuda Hospitals Board's refocus on Utilisation management requires that all staff be knowledgeable about these principles and that when appropriate, they participate in the process. It is another step by the Board to continuously improve the quality of health care for patients.