Staff at the Royal Lancaster Infirmary (RLI) University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) took part in a three day initiative in conjunction with North West Utilisation Management Unit.

The initiative was designed to support trusts to rapidly improve performance towards the operational standard for A&E waiting times that says 95% of patients should be admitted, transferred or discharged within four hours of their arrival at an A&E department.

The 100% Challenge saw the Trust trial a different way of working to improve patient care and experience, improve the experience of staff, and to identify any actions that would support it to deliver a higher level of Emergency Department (ED) performance.

As a result the RLI achieved 93.28% on Thursday 14 September which was higher than the Thursday 7 September figure of 92.50%.

Other positive outcomes included:

 There was a shift in patient discharge activity earlier in the day by at least two to three hours, with an 8% improvement in the level of discharges achieved before 1pm

 Pharmacy saw nearly three times the week day daily average of discharge medication scripts being completed by midda

y  At 6pm that day there was a significant increase in the number of beds available at the RLI.

Foluke Ajayi, Chief Operating Officer, UHMBT, said: “I want to thank all of the teams who took part in this initiative. You should not underestimate the impact you have had on the organisation. We will continue to embrace this way of working and adjust it as necessary as we go along.”

Steps the Trust took included:

 Forming a control room which allowed staff to identify flag obstacles affecting patient flow, better communication and timely resolution of problems

 Focused activity on the flow of patients, introducing an earlier in the day ethos and escalating any delays as early as possible

 ED staff running intentional rounds of each cubicle every hour to review each patient’s management plan, with a view to them being seen by a clinician within the first hour of arrival, referred to the appropriate specialty within the second hour, decision to discharge or admit made by the third hour and acted on within 30 minutes of the decision

 Each ward was visited by a matron to understand which patients were awaiting discharge and what the Trust needed to put into place to make that happen as quickly as possible

There was a series of short meetings held every two hours with key staff at which immediate challenges such as bed numbers, patient transport and discharge medication were raised and actions put into place to ensure the patients were discharged as planned.

Helen Thompson, Deputy Assistant Chief Nurse for emergency care, UHMBT, said: “Today has been really positive and we have seen some earlier discharges than normal. The ED team at the RLI have been absolutely brilliant and have really embraced the initiative.”

Dawn Hooper, of Fleetwood, who had been in ED at RLI for two hours, said: “All the staff have been great and have been in and out to check on me. From the doctors to the paramedics it has been a very positive experience.”
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