An NHS Foundation Trust in the North West of England commissioned Prism Improvement to support the design and delivery of emergency care priorities for one of its hospitals. For a more detailed version of this case study, see the PDF here. 

Following engagement with staff about the improvement opportunities during the Insight and Discovery phase, the Prism Improvement team proposed that the original improvement plan should be split into five workstreams and focus on a smaller number of high-priority areas:

1. Enhance Front Door Capacity and Processes
   • Optimise the use of UTC
   • Strengthen senior decision-making at the front door
   • Develop roles and responsibilities for running the day
   • Relaunch the operating principles of the CDU
2. Reduce admissions by optimising the use of SDEC and Short Stay areas
   • Increase the number of patients through medical SDEC
   • Develop a standalone Frailty SDEC
   • AMU to operate as an assessment area
3. Optimise the daily flow of the site
   • Improve the daily rhythm of the organisation
   • Improve the Weekend Planning
4. Embed a standardised approach to deliver timely discharge
   • Optimise earlier discharge planning and improve consistency of ward discharge processes
   • Optimising digital enablers to support a reduction in discharge delays
5. Collaborate to reduce the number of patients in the Hospital who should be in an alternative care setting​

There was a shared agreement about the opportunities for improvement between staff and the Prism team, which supported the drive to implement the projects within these workstreams. The Prism team specifically supported the delivery of the first four workstreams.

To support the delivery of these workstreams, the Prism team also supported the Trust to embed a robust governance structure. This included agreeing to a fortnightly Emergency Care Improvement Group (ECIG) and ensuring that highlight reports were used in the Group by each workstream accountable officer to update on progress against the delivery of milestones and agreed KPIs. The team also supported project responsible officers to update on progress at workstream meetings, and to agree on what updates would be provided to ECIG

Impact/results:

The current impact of the improvement programme activity on the hospital’s 4-hour performance shows a positive story for the site despite winter pressures and periods of business continuity.

There was a significant focus on testing improvements that are being embedded as good practice ways of working and will therefore support sustainable improvement for the Hospital. This has engaged staff in UEC improvement work and seen improvements in key workstream level metrics, including;

• An increase in the percentage of patients from ED going through Medical SDEC, which in November was at 40.8%, 4.8% over the target for the month
• An improvement in discharges on AMU before 11am, from 11.8% in August to 15.3% in November, and before 4pm, from 44.2% in August to 50.5% in November

More results can be seen in this infographic here.

View the PDF here for more information on the programme and a detailed look at the work undertaken.

If you would like to learn more about how our UEC programmes can support your NHS Trust, click the link below and get in touch.