Hilary Birch and Ian Holroyd, University Hospitals of Morecambe Bay

University Hospitals of Morecambe Bay NHS

Patient flow, patient experience, and staff experience have all been improved by a series of changes made at University Hospitals of Morecambe Bay (UHMB) NHS Foundation Trust.

Led by the trust’s dedicated Matrons for Patient Flow and Clinical Operations Managers Hilary Birch and Ian Holroyd in collaboration with Head of Resilience and Patient Flow, Stuart Hosking-Durn, the changes have saved hours of clinicians’ time. The savings have been made by reducing attendance and the length of patient flow meetings.

The changes introduced include:

Augmentations to the trust’s data system (built in-house) to show inbound patient activity, Emergency Department performance, live bed state and inpatient activity, discharge profiling and live Covid data. 60 different data points have been synthesised into useful dashboards, ensuring data is available at the fingertips of those who need it, and relevant decisions can be taken in a timely manner

Patient flow (bed) meetings three times a day minimum linked to escalation levels which ensures staff attend who can make decisions and ensure the right actions take place to solve issues

Changes to patient flow meetings, with attendees reduced from 40 to 10, and meeting length reduced from an average of 45-60 minutes to around 10 minutes due to the availability of high-quality data and focused agenda

Introducing Click Alert – which shows the exact location of Covid-positive patients are so they can be effectively managed and isolated

Introducing Point of Care Testing (POCT) in ED, enabling rapid testing and outcome reporting for Covid suspected patients. This has reduced ambulance handover delays as patients can be quickly screened and brought into the right area of the department. This rapid testing then enables to Control Room to manage flow by managing bed configuration by colour

A new £350,000 command and control centre will open in March 2021, ensuring that the interim arrangements co-locating Hilary, Ian and colleagues from Covid Command and Control, Clinical Site Management, Resilience and Security are made permanent.

The trust’s data system, the UHMB Analytical Command Centre, is shown on large screens in the offices so the relevant specialists see real-time data about patients in the ED. This include patients waiting to be seen split by majors and minors, ambulances en-route, bed profiles, and waiting times. This system is also available on desktop and mobiles so Senior Clinical and Operations colleagues have access to the same data.

Live bed data is available in the Control Room. Decision-making on beds and capacity is much easier as live bed data is linked to insight into what to expect in ED and data on patients by type at the point of admission.

The impact of the changes can be clearly seen in a recent example. Hilary and Ian requested a ward be reconfigured from red to green, based on the data they had available. This decision unlocked 50 beds (increasing green demand was causing backlog in ED as available beds were red), and over the course of the next four days led to a rapid improvement in site performance resulting in a 97% performance recorded on a Sunday in Winter – a rare occurrence!

The additional data created by the Analytical Command Centre is used to its fullest by a series of meetings which ensure patient flow, patient experience, and staff welfare are always under review. These include:

3-6 times a day bed meetings to review capacity and take decisions. Frequency of meetings is linked to escalation levels to ensure meetings only occur when needed, saving time for senior clinicians and operations colleagues to focus on their day job

Twice-weekly site reconfiguration meetings – as UHMB is a multi-site trust, these are critical to enable senior clinicians and operations colleagues to get together to ensure the optimal configuration of sites to balance demand. This has been crucial during Covid due to the need to have multiple bed types by colour for Infection Control purposes

Daily system meeting, including the CCG and other healthcare partners with a role to play in patient flow

The changes made have allowed the nursing staff at UHMB to be redeployed and upskilled where necessary. For example, a surgery ward was quickly flipped to become a ward for Covid patients, which need specialist respiratory care. The existing nursing staff were blended with respiratory specialists to ensure they were supported to understand the appropriate treatments, while ensuring capacity for patients was maintained.

The standing agenda for every Patient Flow meeting first considers patient safety and experience, then staff safety and welfare. The command centre team has made links with occupational health and uses intelligence from the system, such as deaths by ward, to call in support for staff if needed.

Staff testimonials

“Our control room is constantly being reviewed and updated to provide timely and accurate information so senior clinicians can make the best decisions they can to keep patients and staff safe.

“The information gives an at-a-glance overview of key safety intelligence including information about ambulances expected, ED activity and pressures, ward information, staffing information and where we have beds available at any one time.

“The work led by our clinicians and IT department is inspirational and has been adopted by other Trusts across the country.” Sue Smith OBE, Executive Chief Nurse and Deputy CEO, UHMB

“The Control Room has enabled Patient Flow meetings to focus on the key issues which particularly affect patient safety and experience alongside staff safety and welfare.

“Using the agreed escalation matrix, the frequency of meetings and attendees can change to reflect what and who is needed to ensure timely decision-making and appropriate people taking actions.

“This has freed up considerable time for many colleagues to focus on their day job, but equally they trust the team so that if an escalation occurs they know they have to attend to support decision-making and driving actions to improve performance, reduce patient safety risk and keep colleagues safe and supported.” Kate Maynard, Chief Operating Officer