Only 82.45% of A&E departments are currently meeting the four-hour wait times target of 95% (at December 2017). Yet, staff at Luton & Dunstable Hospital are treating, assessing and discharging an impressive 98.1% of A&E patients within the four-hour target. In an interview with Public Sector Focus magazine, Marion Collict, Head of Operations, Governance and Risk, explained how they’re achieving it.
Vision and empowerment: the cornerstones of success
“There’s no magic formula,” said Marion when asked what it takes to become the country’s top-performing A&E. “It’s partly been about setting a ‘can-do’ culture driven and supported by strong leadership; selling a vision that people are allowed and empowered to make changes and to find solutions. And, of course, we have also made investments: in space, in people and, not least, in technology.”
5 keys to transforming A&E
From 2010, with the appointment of new CEO, Dame Pauline Philip, there were five key changes that fed into Luton & Dunstable’s achievement.
- Expanding the physical area of A&E and reconfiguring to make the most of the space
- Increasing staff numbers – the number of consultants rose from three to 10, and the number of nurses and junior doctors doubled
- Introducing an urgent GP clinic. “Our A&E receives around 450 patients per day on average. Of those, we will immediately stream roughly 100 – 120 to the GP clinic.”
- Taking a holistic view. “The A&E couldn’t meet its targets unless the rest of the hospital – and beyond into community care, social services and our local authorities – were involved. Taking a holistic view of the whole system – rather than being fixated on just fixing A&E – has been fundamental to our success.”
- Using technology to improve efficiency, support the teams and digitise time and resource-intensive processes.
The crucial role of technology
“We used to have people walking round the wards looking for empty beds with paper and pen. By the time staff brought the information back… it was already out of date,” says Marion.
The Trust implemented ExtraMed’s Patient Flow to digitise a number of key processes. One look at a screen informs medical staff about the location and status of every patient in the hospital, enabling them to better manage admissions and discharges. Delays are easily visible enabling faster and more effective action. In addition, the patient flow system alerts A&E when beds become available and wards use it to communicate within the organisation and beyond to social care (who also have access to the system).
“You don’t have to pick up a phone, call the wards, wait for a response, interrupt busy people, or physically go to a ward to get the information you need. It’s hugely time-saving.”
Furthermore, it allows for quick identification of at-risk patients, such as those who could be infectious, tracking who they have been in contact with.
Getting buy-in from the team
Marion admits there were reservations at first, including concern that (back in 2014) staff members could never get to a computer. So, a computer, solely dedicated to Patient Flow, was placed on every ward to resolve the issue.
Selling the benefits to already-pressured nurses was also a potential challenge, but knowing that writing up a handover sheet was no longer needed certainly helped. Now, they simply print one off at each shift change, reducing paper and speeding up the whole process. Finally, selling the benefits to the Trust was made easier by the savings made on staffing.
“Each shift has a controller who monitors what’s going on and, in addition, a person linking to surgery covering both elective and emergency, and another person linking to medicine. Without Patient Flow, and given how busy we are, we’d probably need one person on each of elective and emergency surgery and two or three people doing medicine. I don’t know how other Trusts manage without it.”