A day in the life of Derby Teaching Hospitals A&EAs a winner of this year’s Top Hospitals award for emergency care, Derby Teaching Hospitals NHS Foundation Trust is well-placed to share best practice in accident and emergency care. As well as contributing to our ‘What makes a top hospital – Accident and Emergency Care’ report, we have been working with the trust to deliver study days where NHS colleagues are invited to learn from its experience.
At one of the recent study days delegates from trusts around the UK were given a powerful and thought-provoking insight into the world of the NHS emergency department. The hospital  treats  almost 130,000 patients every year in its adult and children’s Emergency Department. In a tough financial climate that is compounded by increasing demand on services, Derby seems to have cracked one of the hardest healthcare challenges by consistently delivering high quality, safe and efficient A&E services. The trust will be the first to say that there is still a lot of work to do, but judging by the response of the visiting A&E teams from around the country, there is a keen appetite for good ideas. So what are the key take aways that impressed the visitors the most?
1. Create an effective recruitment and retention strategy.
Staff recruitment and retention is a challenge across the NHS but Derby Teaching Hospitals NHS Foundation Trust has been successful in finding and keeping good people. This has been the key to continuous improvement and delivering safe high quality care for patients. An award winning programme designed to develop registrars and move them into consultant positions provides career progression and a steady pipeline of clinicians. Team members say they feel supported day to day and cite a positive culture and team work as contributing factors to job satisfaction. This supportive culture is further demonstrated by a new ‘mental resilience’ initiative that sees sports psychologists working with A&E teams to help them cope with the pressures of busy winters. Posters throughout the department remind staff, patients and visitors of the awards that the trust has won recently for their A&E care. This must be very reassuring for patients, not to mention a welcome reminder of the team’s achievements and successes on the days that don’t go so well.
2. Innovate and think laterally. 
It doesn’t always have to be complex or radical; sometimes the simplest or most obvious changes have the greatest impact. For example, taking the geriatrician to the patient in the Medical Assessment Unit rather than admitting the patient to the geriatric ward (and in many cases discharging very quickly) has resulted in a better experience for the patient and prevented unnecessary admissions. The introduction of some simple yet effective visual management tools has helped the trust to deliver consistent standards of A&E care. ‘TRIPP’ signs throughout the department remind staff of the steps they need to take once patients have been through triage to ensure they feel cared for and fully informed: Toilet, Refreshment,Information, Pain and Pressure Areas.
3. Put yourself in the patients shoes if you want to create a patient-focused service.
The Trust has thought through the impact of environment on various patient groups very carefully. Recognising that an A&E department can be frightening for children, especially those that are injured or ill, a different entry point and treatment area was created to provide a more fun and engaging setting. Although separate, an adjacent adult unit allows the A&E infrastructure to be flexed in response to demand. When adult patients with mental health problems became agitated in the designated assessment room, staff realised that the clinical environment was counterproductive to delivering a good outcome. The Trust added coloured artwork to the room to soften it, making it more welcome and calming for patients experiencing a high degree of stress and anxiety. On the other side of the assessment area is another private room; this one is designated for women in early pregnancy who may be miscarrying. Respect and dignity are values that run deep here but patient empowerment is just as important. The decision to remove trollies from the department aims to create an active rather than a passive patient and those that are unable to walk are moved around on beds.
4. Understand how technology can best support the department and staff. 
Electronic white boards are used at Derby Teaching Hospitals to provide real time information about the status of every patient, ensuring that staff remain informed and able to respond quickly to changing situations. This white board system also supports the ‘virtual ward’ where patients are cared for at home but still appear on the hospital whiteboard so that their care can be managed effectively by a lead consultant and multi-disciplinary team. The operations control room is the heartbeat of the hospital, a busy and energised area where you can see bed utilisation and changes in real time. Bed meetings take place every day at 9am, 12pm, 4pm and, when needed, a daily wrap up at 6pm. We were lucky enough to observe one of these discussions and were incredibly impressed by such a short, focused meeting where everything was under tight control and every individual engaged and informed.

5. Focus on flow.
Not a new concept but the solutions can be. The Derby A&E pit stop is an effective way of getting new arrivals to the most appropriate care and maintaining flow. The aim is to focus on moving the patient through the department as quickly as possible and where appropriate this is supported by published and standardised ambulatory care pathways for patients who can be immediately transferred from A&E to the Ambulatory Care Centre for fast trach diagnostics and treatment before being discharged home rather than being admitted to a hospital bed.. The Trust has also introduced ‘Super Saturdays’; a call to arms during the winter period when the aim is for teams across the hospital to provide services like a usual week day ensuring high numbers of weekend discharges to make way for those who need to be admitted to hospital over the weekend for acute care. . This means that come Monday, the system is under control rather than awash with emergency patients. The SHOP process on all wards provides a prioritisation process for staff to assess and make decisions on patients, which has proven to increase flow and while reducing length of stay. Ward rounds start with the Sickest then the Home discharges and finally the Others, before Planning starts for the rest of the day.
Anyone visiting the A&E department will be struck by the positive atmosphere and will undoubtedly come away feeling invigorated, positive and full of ideas. There are so many interesting projects and initiatives underway – too many to mention here but if you ever get the chance to visit, you should jump at the chance.
To register your interest in attending a future A&E Study Day at the Royal Derby Hospital please email info@chks.co.uk. 
To find out more about how CHKS can help you understand A&E performance and turn A&E data into actionable information, please contact us on 01789 761 600 or email info@chks.co.uk
You can also find out more about our latest A&E analytics programme here.

By Lisa Kean, Head of Marketing - Capita Health PartnersAs a winner of this year’s Top Hospitals award for emergency care, Derby Teaching Hospitals NHS Foundation Trust is well-placed to share best practice in accident and emergency care. As well as contributing to our ‘What makes a top hospital – Accident and Emergency Care’ report, we have been working with the trust to deliver study days where NHS colleagues are invited to learn from its experience.
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