Case Study Challenge

Swindon Clinical Commissioning Group (Swindon CCG) requested the support of maxwell stanley to review the current Ambulatory Emergency Care (AEC) pathways, activity and tariff charges, analyse the potential scope and financial impact of extending current AEC and provide recommended pathway redesigns.

Swindon CCG benefited from maxwell stanley’s blended analytical, clinical, and coding-led approach.

Building on the initial analysis undertaken by our CSU, maxwell stanley provided the necessary evidence to formulate a highly credible challenge.  This was submitted to one of our acute providers which yielded successful results.

I was particularly impressed with the professionalism provided bymaxwell stanley and the helpful guidance provided enabling us to refine what we were asking for in order to achieve the desired output from the subsequent analysis

Clinical Chair, Swindon Clinical Commissioning Group

Case Study Approach


Our PbR Analysts completed activity trend analysis using SUS activity data to ascertain the historic and current volume of activity in each of the 49 AEC clinical scenarios (as defined by The NHS Institute for Innovation and Improvement’s Directory of Ambulatory Emergency Care in Adults). All non-elective short stay admissions activity data was analysed to determine AEC activity falling outside the defined clinical scenarios.

The data was also analysed to understand the current tariffs charged for this activity, including those admissions within  the 19 scenarios charged as a Same Day Emergency Care Best Practice Tariff (BPT). HRG and tariff trend analysis improved our client’s understanding of AEC and established an accurate activity and financial baseline.


Patient level data analysis by our Analysts and our GPs produced a targeted case note selection for a clinical audit to understand opportunity to transfer same day emergency care activity to a non-admitted setting, and opportunity to reduce length of stay for AEC admissions.


Our GPs and Clinicians completed a targeted clinical audit of patient case notes to qualify data analysis conclusions and provide clinical evidence to support proposed recommendations for AEC redesign.

National benchmarking of AEC delivery  was completed, analysing percentages of current non-zero LoS admissions for each of the 49 scenarios, to understand the scope to reduce the length of stay for these admissions.  The clinical audit quantified whether delayed discharges are impacting on patient LoS.


Our proposed recommendations for AEC redesign included challenging admissions where community pathways already exist, extension of appropriate community pathways beyond those already implemented within the health  economy, methods to reduce LOS for admissions within the 49 AEC scenarios with higher than expected LOS, and introducing local tariffs for activity delivered on an ambulatory basis that fell outside of the criteria for the 49 AEC scenarios.

Case Study Outcomes

A Pathway Review and Redesign Report was produced containing:

  • Detailed understanding of current delivery of Ambulatory Care and tariffs charged
  • Comparison of Ambulatory Care with national benchmark standards
  • Targeted case note review method and results
  • Conclusions of maxwell stanley investigation
  • Activity and financial impact analysis
  • Recommendations for potential pathway redesign