National support for our hard-pressed emergency departments
Our three A&Es are to get intensive support from national experts to help our hospitals maintain the quality and safety of care in the run-up to winter.
The trust is one of a dozen chosen by NHS England for a pilot scheme to boost our existing improvement plans to reduce unnecessary admissions, ensure patients are treated promptly, and don’t stay longer in hospital than they need.
The Rapid Improvement Offer (RIO) follows a national review of every acute provider but is tailored to the circumstances of the chosen sites. Over the next three months, each will receive dedicated day-to-day support from a clinical expert and two practitioners from the Emergency Care Improvement Support Team.
They will help our clinical and managerial colleagues identify what further changes can be made to improve flow through the hospitals, reduce the likelihood of 12-hour waits in A&E, and speed up ambulance handovers.
We operate some of the busiest A&Es in the country, with over 44,000 attendances in July. We see and treat seven out of ten within the national four-hour standard.
The expansion of Same Day Emergency Care on each site is helping manage demand, and these units saw a record 4,403 patients in July.
However our performance is lagging behind our peers, and too many patients are still spending more than 12 hours in an emergency department (ED).
We regularly have over 100 patients occupying beds when they are ready to be discharged, and during July we also had a record number of mental health patients occupying ED beds, averaging 28 every day.
Delays with patients ready to leave The Royal London after specialist surgery contributed to escalating operating pressures on 15 days last month, and this is one area where the RIO programme could have a major impact.
Meanwhile teams continue to make everyday improvements where they can. For example, Newham introduced a new “pit-stop process” to review every patient after three hours in ED and avoid inadvertently overshooting the four-hour target.
Whipps Cross revised the staffing model in its Emergency Assessment area to improve triage. It has also doubled the number of cubicles available to improve privacy for patients, and put curtains around all temporary trolleys in the corridor.
The REACH ambulance assessment filter at The Royal London successfully diverted over 600 patients in July, and a further 150 patients seen by the mobile Physician Response Unit didn’t need to come to hospital either.
Rebecca Carlton, group chief operating officer, said:
“It is widely recognised that strong clinical and managerial leadership is key to the safe delivery of urgent and emergency care, and our hospital teams are determined to make a success of this opportunity to increase their bandwidth.”