- Led by Nottingham University Hospitals NHS Trust.
- Implemented with all non-injury-related adult attendances at the Trust’s Emergency Department, and aimed to improve patient and staff satisfaction and reduce length of stay, unnecessary investigations, admissions and crowding.
- Trialled an admission prediction tool that uses a scoring system to identify both patients who are likely to be admitted and those likely to be discharged.
- Project ran from September 2016 to November 2017.
Emergency departments are continuing to see a rise in attendances. The resulting crowding contributes to prolonged length of stay and poor patient experience. Late decision making or delayed senior involvement is thought to contribute to crowding.
This project looked at how best to direct the workload of senior clinicians to maximise their clinical time, prioritise and streamline workload, and prevent crowding.
It involved using a prediction tool, devised in Glasgow, which identifies patients who are likely to be admitted or discharged.
In a trial of the system, it was applied to all adult non-injury cases attending the emergency department at Nottingham University Hospitals NHS Trust between May and September 2017, which amounted to more than 50,000 patients. The time the score generated and the time a real decision to admit was applied to a patient were compared – this showed that if the score had been used as a decision to admit, the decision would have been made an average of 2.5 hours earlier.
This earlier identification of patients who are likely to be admitted means cases can be highlighted to hospital bed managers, allowing for better planning and flow. Identifying those who are likely to be discharged means these cases can be highlighted to senior clinicians, and rapid assessment and treatment can be undertaken.
The main challenge was around improving the predictive accuracy of the score, as some concerns were raised about increasing admission rates. Work is continuing to improve its accuracy before it can be embedded into practice.
For more information about this project, please, Consultant Emergency Physician and Service Improvement Lead for Emergency Department, Nottingham University Hospitals NHS Trust.
About this programme
This programme supports up to 23 projects with up to £75,000 to test and develop innovative ideas and approaches, put them in...
You might also like...
Patients finding it harder to access general practice, but those in poorer areas report greater problems
OnlyWan response to British Social Attitudes Survey on emergency care.
As A&E attendances hit a record high, Tim Gardner explores the divergent pressures facing emergency departments across Englan...
Wondering how to get started with your #QualityImprovement project? Read an article in our #QI series with…
Work with us
We look for talented and passionate individuals as everyone at the OnlyWan has an important role to play.View current vacancies
The Q Community
Q is an initiative connecting people with improvement expertise across the UK.Find out more