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of our @EmergencyMedBMJ paper on hospital flow:
Effect of hospital interventions to improve patient flow on emergency department (ED) clinical quality indicators
You can read the full paper here:
https://emj.bmj.com/content/early/2020/09/02/emermed-2019-208579.full
of our @EmergencyMedBMJ paper on hospital flow:Effect of hospital interventions to improve patient flow on emergency department (ED) clinical quality indicators
You can read the full paper here:
https://emj.bmj.com/content/early/2020/09/02/emermed-2019-208579.full
Background
Nationally, approximately 25% of patients requiring acute admission breach the 4-hour ED standard.
Poor inpatient flow is a key reason why patients spend more than 4 hours in ED.
It also affects other areas of the system: eg. cancelled elective surgery
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Nationally, approximately 25% of patients requiring acute admission breach the 4-hour ED standard.Poor inpatient flow is a key reason why patients spend more than 4 hours in ED.It also affects other areas of the system: eg. cancelled elective surgery/2
@YeovilHospital in 2015/6
Cancelled elective surgery (peaked Mar 2016)
Breach of 4-hour standard since Jul 2015
A terrible @CareQualityComm report
First attempt to improve inpatient flow failed:
Healthcare staff/ quality care vs. management/ operational efficiencies
/3
Cancelled elective surgery (peaked Mar 2016)Breach of 4-hour standard since Jul 2015A terrible @CareQualityComm reportFirst attempt to improve inpatient flow failed:
Healthcare staff/ quality care vs. management/ operational efficiencies
/3
Second attempt:
We employed a design science research process.
This linked context, system and outcome to an initial generic design which was then refined through an iterative process.
It is described here:
https://www.stemlynsblog.org/jc-improving-patient-flow-st-emlyns/
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We employed a design science research process.
This linked context, system and outcome to an initial generic design which was then refined through an iterative process.
It is described here:
https://www.stemlynsblog.org/jc-improving-patient-flow-st-emlyns/
/4
The first outcomes:
Morning Monday: prioritise discharges on Monday mornings
DTOC Thursday: established partnerships with social care through multidisciplinary stakeholder meetings each Thursday
30-bed Friday: ensure at least 30 beds were available by Friday afternoon
/5
Morning Monday: prioritise discharges on Monday morningsDTOC Thursday: established partnerships with social care through multidisciplinary stakeholder meetings each Thursday30-bed Friday: ensure at least 30 beds were available by Friday afternoon/5
Outcomes continued
Next step Tuesday: encouraging staff innovation to reduce next step in care delays
14-day Wednesday: stepping up completion of care/ addressing discharge destination
Weekend flow: Redesign of weekend staffing to facilitate a discharge team
/6
Next step Tuesday: encouraging staff innovation to reduce next step in care delays14-day Wednesday: stepping up completion of care/ addressing discharge destinationWeekend flow: Redesign of weekend staffing to facilitate a discharge team/6
The last outcome was enhancing the SDEC service.
There were three basic themes:
Facilitate efficient inpatient care
Ensure timely appropriate discharges
Facilitate out-of-hospital, same-day acute care
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There were three basic themes:
Facilitate efficient inpatient care Ensure timely appropriate discharges Facilitate out-of-hospital, same-day acute care/7
We used the the @DHSCgovuk, @RCollEM & @theRCN ED clinical quality indicators to measure the effect of the intervention.
It was *very* beneficial on all metrics
despite an 6-9% year on year increase in attendance
minimal changes to ED staffing and service configuration
/8
It was *very* beneficial on all metrics
despite an 6-9% year on year increase in attendanceminimal changes to ED staffing and service configuration/8
Although the initial intervention period was completed by Sep 2016, the iterative process of identifying problems, seeking solutions and rapid implementation continues still.
It has survived a 6-month sabbatical by its lead @SethiSimon.
It has become culture @YeovilHospital
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It has survived a 6-month sabbatical by its lead @SethiSimon.
It has become culture @YeovilHospital
/9
@YeovilHospital ED was one of only three English hospitals to achieve overall compliance with the 4-hour ED standard in 2018 and the only English hospital to achieve overall compliance with the 4-hour ED standard in 2019
https://www.ft.com/content/abf71964-25a0-11ea-9a4f-963f0ec7e134
https://www.dailymail.co.uk/health/article-7895133/Only-ONE-NHS-trust-hit-target-seeing-95-E-patients-four-hours-2019.html
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https://www.ft.com/content/abf71964-25a0-11ea-9a4f-963f0ec7e134 https://www.dailymail.co.uk/health/article-7895133/Only-ONE-NHS-trust-hit-target-seeing-95-E-patients-four-hours-2019.html/10
Post your comments below.
We're currently looking for help with further qualitative research. DM me if you have an interest in EM and content analysis.
Further reading:
https://nhshorizons.passle.net/post/102f56u/reducing-ed-crowding-and-improving-flow-at-yeovil-what-did-we-do
https://onlinelibrary.wiley.com/doi/abs/10.1002/joom.1077
/end
We're currently looking for help with further qualitative research. DM me if you have an interest in EM and content analysis.
Further reading:
https://nhshorizons.passle.net/post/102f56u/reducing-ed-crowding-and-improving-flow-at-yeovil-what-did-we-do https://onlinelibrary.wiley.com/doi/abs/10.1002/joom.1077/end
