Cambridgeshire – MADE and Exemplar Ward Programme

Cambridgeshire Local Health Community are members of the emergency care improvement programme (ECIP) and are also part of a larger urgent and emergency care vanguard programme. Cambridgeshire are on an improvement journey and are undertaking multiple initiatives across the whole system including an exemplar ward programme and MADE events (multidisciplinary accelerated discharge events). The first MADE event was held at Cambridge University Hospitals NHS Foundation Trust in July 2015 (indeed the title MADE was first coined in Cambridge) followed by the launch of an agreed trust wide implementation of the SAFER patient flow bundle ( in August 2015.

The December MADE was an intensive process running over two days with input from senior, operational and clinical leads across the system including the acute trust, the CCG, social care, GPs, community care (including therapists & community matrons), mental health teams, patient representatives & the voluntary sector. Approximately 25-30 people attended a briefing session and then split into teams to review allocated wards. MADE teams worked with ward clinical leads to review all the patients on the ward (not simply those with extended length of stay) to identify and remove barriers to progressing patient care and to achieve early and appropriate discharges. Ward staff were challenged to have zero tolerance on delays, thinking ‘home first’ with the right level of support. If it was not possible to resolve the delay then the aim was to both escalate the issue to achieve a resolution and to discuss and agree options to prevent this delay occurring again for the next patient. Daily feedback sessions were attended by senior leaders from across the system so that decisions could be made quickly to begin to address difficult issues. Wards were originally selected for the exemplar program in December based on a high level of stranded patients, but this expanded rapidly with the January cohort deliberately including both surgical and medical wards with well-established and effective board rounds alongside wards that didn’t run board rounds at all and also included short-stay wards.

All wards involved in MADE to date have agreed to become exemplar wards to implement the SAFER flow bundle. MADE is now an established process with good buy in, attendance and enthusiasm across the whole system and positive feedback from wards, executives and whole system partners. The current improvements have contributed to a 31% improvement in discharges and 51% improvement in morning discharge over the last eight months.

Cambridge disch time

There is increased acceptance that everyone needs to focus on managing the next step and that when multi-disciplinary teams do so that the impact is often greater than they expected. There has been a real buzz in the room each time MADEs have run and a collective sense of purpose which continues on the exemplar wards. There are now 11 exemplar wards in CUH embedding the SAFER bundle - this is approximately a quarter of the wards, all in the space of 5 weeks (which included Christmas!). The trust made the local news when they reported to their Trust Board that they had achieved the 4 hour standard at 95.6% in December 2015 for the first month in 22 months.

Cambridge 95 percent

For further information - please contact:

[email protected] - Director of Operations

[email protected] - Director of Integration
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