Patient safety at the core of improved service at Medway Emergency Department

Date: 16 November 2016

ED staff proudly present regional performance scores for April showing the Trust as the second best performing ED across the region. Back row, left to right: Kirsty Mason, Larry Watts, Cliff Evans, Linda Hubble, Kelly Diddell, John Ferguson, Elsward Samuels. Middle row, left to right: Sarah Harrison, Alan Wooley, Kathy Ward, Heather Macfarlane, Iuliana Clark. Seated, left to right: Gaynor Welton, Blessmarie Revelo, Nicola Lowdell, Barbara Hales
ED staff proudly present regional performance scores for April showing the Trust as the second best performing ED across the region

In February, we launched a new way of providing care for people using its Emergency Department (ED), underpinned by a new triage system.

Developed by a team of specialist clinicians here at the Trust, the project has been overseen by educational lead and Consultant Nurse Cliff Evans. Along with his ED colleagues Andrew Stradling, Clinical Lead; John Ferguson, General Manager; Clare Hughes, Senior Matron; and Michelle Theokli, ED Matron, they have developed and launched an improved service aimed at providing each patient with high quality, safe care that is respectful of individual dignity and privacy.

Cliff Evans explains, ‘Each patient coming to the ED is given an assessment, which includes a National Early Warning Score (NEWS). If a patient needs further investigation or treatment, they are given a care plan, and clinical care begins directly following triage. This avoids unnecessary delay and aims to get the best possible outcome for every patient.

‘Our approach to emergency medicine is about much more than simply meeting targets. We want to give each person who comes to the ED safe and effective care. We need the ability to respond quickly, so identifying severe illness early and prioritising each patient is essential. We know this is a big challenge.’

Modernising the Trust’s ED has been a massive project, and has involved everything from review of the clinical skill mix in the team, to looking at better use of physical space within the department, all with a focus on giving people better, faster care that has safety at its core.

Building and developing a team that is big enough to handle the increasing number of people coming through its doors is another challenge. When it was originally set up, the Trust’s ED was designed for an annual patient turnover of around 44,000. Population growth has meant that the ED now sees over 100,000 patient visits ever year, and this number is growing. The modernisation plan includes a local and international recruitment drive aimed at bringing more clinicians to the team.

On a given day, the ED can see around 360 undiagnosed patients, including over a hundred ambulance attendances, and this number is rapidly increasing. To meet this demand and continue to deliver a high quality service, a significant element of Cliff’s role is supporting and facilitating the ED with the education and empowerment they need to provide effective care 24 hours a day, seven days a week.

An education programme has been rolled out that includes continuous professional training and development for each clinician in the team. ED nurses complete a two-day intensive training programme on the specifics of emergency care. Nurses and doctors attend sessions together on new national guidance and lessons learnt from previous experiences, to keep pace with the latest approaches and innovations. To further strengthen the service, a new role of Associate Practitioner was introduced, which has increased the level of care and support for patients in the ED.

Physical space in the ED has been reorganised so that patients who are booked in for treatment are now in a separate area of the ED, away from the main entrance. Here they are closely monitored by doctors and nurses who can respond quickly if their condition worsens. This is proving highly effective at giving ED patients a better overall experience and safer, faster treatment. A major refurbishment plan will begin this year to further improve the use of space, with completion expected in December 2017.

Reflecting on the changes to date, and of that to come, Cliff adds, ‘Since my arrival at Medway Foundation Trust, I have been overwhelmed by the support we have received from all areas of the Trust. The building project team headed by Brian Edwards and the lead for health informatics, Jo Lambert, have gone that extra mile to move our new strategy forward at an incredible speed. With the support of experienced consultant colleagues, and the nursing and reception team, we are working to develop a service that will be an inspiration to colleagues across the NHS.’

  • Summary:

    In February of 2016, Medway launched a new way of providing care for those using its Emergency Department (ED), underpinned by a new triage system.