Twitter https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> 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">https://emj.bmj.com/content/e...

Background
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">Nationally, approximately 25% of patients requiring acute admission breach the 4-hour ED standard.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">Poor inpatient flow is a key reason why patients spend more than 4 hours in ED.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">It also affects other areas of the system: eg. cancelled elective surgery
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/2

@YeovilHospital in 2015/6
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">Cancelled elective surgery (peaked Mar 2016)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">Breach of 4-hour standard since Jul 2015
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔘" title="Optionsfeld" aria-label="Emoji: Optionsfeld">A terrible @CareQualityComm report

First attempt to improve inpatient flow failed:
Healthcare staff/ quality care vs. management/ operational efficiencieshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😠" title="Wütendes Gesicht" aria-label="Emoji: Wütendes Gesicht">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/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/
https://www.stemlynsblog.org/jc-improv... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/4

JC: Improving patient flow. St Emlyn's • St Emlyn's

How Yeovil hospital achieved the 4-hour standard in emergency medicine. Stevan Bruijns reviews the paper and methodology. #FOAMed

https://www.stemlynsblog.org/jc-improving-patient-flow-st-emlyns/

The first outcomes:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☀️" title="Sonne mit Strahlen" aria-label="Emoji: Sonne mit Strahlen">Morning Monday: prioritise discharges on Monday mornings
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚦" title="Vertikale Verkehrsampel" aria-label="Emoji: Vertikale Verkehrsampel">DTOC Thursday: established partnerships with social care through multidisciplinary stakeholder meetings each Thursday
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛏️" title="Bett" aria-label="Emoji: Bett">30-bed Friday: ensure at least 30 beds were available by Friday afternoon
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/5

Outcomes continued
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👟" title="Sportschuh" aria-label="Emoji: Sportschuh">Next step Tuesday: encouraging staff innovation to reduce next step in care delays
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🗓️" title="Spiralkalenderblatt" aria-label="Emoji: Spiralkalenderblatt">14-day Wednesday: stepping up completion of care/ addressing discharge destination
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔚" title=""End" mit nach links zeigendem Pfeil darüber" aria-label="Emoji: "End" mit nach links zeigendem Pfeil darüber">Weekend flow: Redesign of weekend staffing to facilitate a discharge team
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/6

The last outcome was enhancing the SDEC service.

There were three basic themes:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1"> Facilitate efficient inpatient care
https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2"> Ensure timely appropriate discharges
https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3"> Facilitate out-of-hospital, same-day acute care

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/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 metricshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😀" title="Grinsendes Gesicht" aria-label="Emoji: Grinsendes Gesicht">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">despite an 6-9% year on year increase in attendance
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">minimal changes to ED staffing and service configuration
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/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
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/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://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen"> https://www.ft.com/content/abf71964-25a0-11ea-9a4f-963f0ec7e134
https://www.ft.com/content/a... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen"> https://www.dailymail.co.uk/health/article-7895133/Only-ONE-NHS-trust-hit-target-seeing-95-E-patients-four-hours-2019.html
https://www.dailymail.co.uk/health/ar... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/10

Yeovil hospital offers hope for UK’s stretched NHS

Medical staff say shift in approach will help them weather winter crisis

https://www.ft.com/content/abf71964-25a0-11ea-9a4f-963f0ec7e134

Post your comments below.

We& #39;re currently looking for help with further qualitative research. DM me if you have an interest in EM and content analysis.

Further reading:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1"> https://nhshorizons.passle.net/post/102f56u/reducing-ed-crowding-and-improving-flow-at-yeovil-what-did-we-do
https://nhshorizons.passle.net/post/102f... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2"> https://onlinelibrary.wiley.com/doi/abs/10.1002/joom.1077
https://onlinelibrary.wiley.com/doi/abs/1... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/end

Reducing ED crowding and improving flow at Yeovil: What did we do? (via Passle)

In my previous blog I wrote about how we approached change in order to reduce the ongoing crowding in our emergency department (ED). This blog focuses o...

https://nhshorizons.passle.net/post/102f56u/reducing-ed-crowding-and-improving-flow-at-yeovil-what-did-we-do