RCEM highlights importance of patient flow in emergency departments

In a recent article for Politics Home, The Royal College of Emergency Medicine (RCEM) outlined the challenges emergency departments face due to hospitals operating at full capacity.

Rising pressures are increasing the risk to patients and burn-out of NHS staff is also a significant risk to patient safety. The article emphasises the crucial role patient flow plays in the effective functioning of the emergency department.

“A lack of patient flow through an ED is the single most pernicious way to render the system both inefficient and ineffective,” said the RCEM. “Not only are paramedics unable to attend other 999 calls but patient outcomes are worsened; there is more pain, less care and more deaths.”

Tackling ‘exit block’

RCEM has previously spoken out against ‘Exit Block’ – when the exit from an Emergency Department is effectively blocked because of a lack of available beds. It has urged Trusts to ensure that a “reliable flow metric” is created to safeguard patients and optimise patient flow in emergency departments.

The four-hour standard is currently under review in England and Wales by NHS England and NHS Improvement (in the Clinical Review of Standards project). While the current standard encourages patient flow up to the four-hour point, there is little incentive to prioritise for those whose wait goes beyond that time.

RCEM said: “We are eagerly awaiting the results of the testing and it is our view that unless better metrics can be developed then the four hour standard should be retained.”

How ExtraMed supports patient flow in emergency departments

The “reliable flow metric” RCEM highlights above is what ExtraMed’s Patient Flow system provides in abundance. For example, ExtraMed customer Luton and Dunstable Hospital is treating, assessing and discharging an impressive 98.1% of A&E patients within the four-hour target.

The Trust implemented ExtraMed’s Patient Flow to digitise a number of resource-heavy processes. This included electronic whiteboards and desktop applications, monitoring patient flow and bed availability in real time.

Patient status-at-a-glance

One look at a screen informs staff about the location and status of every patient in the hospital, enabling them to better manage admissions and discharges. Gone are the days of walking the wards with a clipboard. 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.

What’s more, a Patient Tracking List (PTL) highlights any blockages, and a robust escalation procedure exists to resolve such issues. A twice weekly teleconference is supported by the PTL which allows staff to identify pinch points and work on developing clear actions and outcomes.