Managing patient flow at Derby Teaching Hospitals NHS Foundation Trust

Derby Teaching Hospitals NHS Foundation Trust provides both acute hospital and community-based health services, serving a population of more than 600,000 people in and around southern Derbyshire. It runs two hospitals: the Royal Derby Hospital, which incorporates the Derbyshire Children’s Hospital, is a busy acute teaching hospital; London Road is the Trust’s community hospital. Its community services are based in health centres and GP practices across the region, providing care to patients in their own homes.

The Royal Derby Hospital is the newest hospital in the East Midlands. The trust treats a million patients each year and has the only rooftop helipad in the region. Its busy emergency department sees around 320 patients each day.

According to chief executive Sue James, the winter of 2012/13 was a bad time in the emergency department. She says: “We were not hitting our targets and consultants were critical of the fact that the hospital was awash with emergency department patients. At the time, safety and the patient experience was the concern.
“Everyone was blaming each other for the situation and it was clear that something needed to change. We decided to hold a no-blame summit, inviting all the key players to be present, including social services, GPs and doctors from our department and from emergency medicine.

“An urgent care board was set up, which has transformed the way we work and, in some respects, was ahead of its time. It was clear everyone needed to work together – in the hospital and the community. The board focused on four major work streams: keeping patients out of hospital; working in the emergency department itself; managing flow through the hospital; and discharging patients.

“The crucial thing we did was to ensure that each work stream was led by a consultant or doctor. The urgent care board is chaired by a GP. It’s evident that the whole hospital needs to work together to ensure patient flow is continuous.”

Among the initiatives was the development of a range of systems around daily board rounds. Everything that has happened to the patient is recorded on electronic whiteboards. Consultant and teams spend half an hour on this each morning. Lots of training has been done to ensure a consistent approach.

For the judges of the CHKS excellence in A&E award, the trust was a worthy winner as it showed a clear focus on the patient experience, demonstrating compassionate care and good outcomes. Crucially it has established strong links throughout the system, within the hospital and in the community. The judges felt excellent in-hospital front-door support was combined with a solution-focused approach, with innovations such as virtual hospital wards. The trust also demonstrated strong leadership, which is essential for a smooth-running department.

This is just one of the sections from our forthcoming ‘What makes a top hospital?’ report on accident and emergency care which will be published on 9th September. This will be available at http://www.chks.co.uk.Derby Teaching Hospitals NHS Foundation Trust provides both acute hospital and community-based health services, serving a population of more than 600,000 people in and around southern Derbyshire. It runs two hospitals: the Royal Derby Hospital, which incorporates the Derbyshire Children’s Hospital, is a busy acute teaching hospital; London Road is the Trust’s community hospital. Its community services are based in health centres and GP practices across the region, providing care to patients in their own homes.

The Royal Derby Hospital is the newest hospital in the East Midlands. The trust treats a million patients each year and has the only rooftop helipad in the region. Its busy emergency department sees around 320 patients each day.

According to chief executive Sue James, the winter of 2012/13 was a bad time in the emergency department. She says: “We were not hitting our targets and consultants were critical of the fact that the hospital was awash with emergency department patients. At the time, safety and the patient experience was the concern.
“Everyone was blaming each other for the situation and it was clear that something needed to change. We decided to hold a no-blame summit, inviting all the key players to be present, including social services, GPs and doctors from our department and from emergency medicine.

“An urgent care board was set up, which has transformed the way we work and, in some respects, was ahead of its time. It was clear everyone needed to work together – in the hospital and the community. The board focused on four major work streams: keeping patients out of hospital; working in the emergency department itself; managing flow through the hospital; and discharging patients.

“The crucial thing we did was to ensure that each work stream was led by a consultant or doctor. The urgent care board is chaired by a GP. It’s evident that the whole hospital needs to work together to ensure patient flow is continuous.”

Among the initiatives was the development of a range of systems around daily board rounds. Everything that has happened to the patient is recorded on electronic whiteboards. Consultant and teams spend half an hour on this each morning. Lots of training has been done to ensure a consistent approach.

For the judges of the CHKS excellence in A&E award, the trust was a worthy winner as it showed a clear focus on the patient experience, demonstrating compassionate care and good outcomes. Crucially it has established strong links throughout the system, within the hospital and in the community. The judges felt excellent in-hospital front-door support was combined with a solution-focused approach, with innovations such as virtual hospital wards. The trust also demonstrated strong leadership, which is essential for a smooth-running department.

This is just one of the sections from our forthcoming ‘What makes a top hospital?’ report on accident and emergency care which will be published on 9th September. This will be available at http://www.chks.co.uk.Derby Teaching Hospitals NHS Foundation Trust provides both acute hospital and community-based health services, serving a population of more than 600,000 people in and around southern Derbyshire.