Improving Urgent and Emergency Care - One Plan
We know that patients are facing long waits in the Emergency Department and in ambulances at times. To help address this, our 'One Plan' is a roadmap for improving our patient safety and the experience patients have whilst in our care.
The plan focuses on speeding up access so people get to the right service, at the right time, and to the people with the right skills. We know this improves the quality of outcomes. We are working with colleagues in Livewell Southwest on these plans too, as admission avoidance and timely discharge relies on the availability of community services for people to use instead of attending and being admitted to hospital.
As the plan progresses and starts to take shape, we will bring you examples of how our colleagues are making inroads to improving our performance, and patient experience. Our One Plan focusses on three key areas:
Admission avoidance
Avoiding admission by treating people in the community and as same day emergency care patient reducing the requirement for them to be admitted:
- Increasing virtual ward capacity, particularly for the frail elderly
- X-ray car to attend patients with suspected fractures in the community
- Hot clinics for patients to return to
- Direct referral into specialist services e.g. paediatrics, early pregnancy, fractured neck of femur (NOF), urology
- Increase community services particularly for frail patients
- Right sized assessment units
Dynamic flow
Making sure patients get to the right place for their care with the right person
- Right sized Same Day Emergency Care (SDEC) and Medical Assessment Units (MAU)
- Senior decision makers at key points in patient pathways
- Supporting non-operable fracture patients in the community
- Increase alternative ambulatory services
- Increasing community beds for EOL
- Ambulances taking patients direct to SDEC and other areas, e.g. for stroke care and fractured NOF
- Alternative pathways for trauma
Timely discharge
Getting patients home to their place of residence asap
- Increasing the number of complex patients discharged home with appropriate support
- Community IV antibiotics
- Timely clinical review for outlier patients
- Improved management of frail people to improve rehabilitation/recovery
- Enhanced therapy pathways for the assessment and management of patients
Mark Hackett talks about the One Plan
In this video Mark Hackett, our Interim Chief Executive, explains the ‘One Plan’ and details some of the improvements we have rolled out in the past few months, and what we are working on over the summer to continue to make things better for patients needing urgent and emergency care.
One Plan — detailing our improvements so far
Teams across the trust have been hard at work in making improvements for staff and patients. As the Single Improvement Plan evolves and takes shape, colleagues are sharing their stories of success - please take a good look at the short films below.
Our new Medical Receiving Unit on Tamar
On Wednesday 31 July we opened Tamar Ward as a new 22-bed Medical Receiving Unit (MRU). We spoke to Consultant Physician Dr Austin (Oz) Hunt and Physician Associate Sam Evans, about why this unit has been set up by the Medicine Care Group and how it will operate.
The space will work for the benefit of patients by allowing the medical take to come direct to MRU both from ED and from the community, meaning that we can accommodate those patients that need to come to acute medicine. Oz and Sam also filled us in on how this significant change for UHP is part of an important national research project.
We have expanded our Same Day Emergency Care provision
We are pleased to say that the move of Medical Same Day Emergency Care (MSDEC) into Outpatients has been successful and is now open.
The vacated space on Tamar Ward is also now open, as an extension of the Medical Assessment Unit.
Clinical Support Services are working to improve UEC
We spoke to Consultant and Service Line Director for Clinical Support Services, Lucy McGavin, who explained what is being done by colleagues in Clinical Support to help improve care for Urgent and Emergency patients
Children get quicker access to Children's Assessment Unit
Staff in the Paediatric Emergency Department and Children’s Assessment Unit have made some changes recently to aid the pressure on Urgent and Emergency Care.
With enhanced communication between staff in ED and CAU, the use of senior decision makers in ED, and greater visibility of the 4-hour target, children are now being brought up to CAU on level 12 quicker than before.
Urology lead the way
In this video, our urology team describe how they are among the first in the country to introduce a Urology Same Day Emergency care model and the difference it is making to patients with urological problems attending as emergencies.
Marlborough's improvement work
Marlborough Ward Manager Nick Winter talks about the work he and his team are doing to improve patient flow and discharge patients home or onto their next place of care as soon as possible.
Stannon ward: reducing length of stay through enhanced communication
Stannon Ward have been making some big improvements in reducing their Length of Stay. The ward began trailing new initiatives in November 2023, traditionally a time when patients requiring care on Healthcare of the Elderly wards starts to increase, and have seen some impressive outcomes:
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Patients discharged from Stannon ward are now staying just over two days less on average then compared to last year
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This has been possible by reducing the amount of time patients wait for key activities to happen whilst on the ward
You can watch the video below of the staff on Stannon explaining how their processes have made a difference to LoS, and why clear communication with patients, like Andrew Davis, are so important.
Virtual Wards
The UHP Virtual Ward supports patients to receive the acute care, monitoring and support they need in the place they call home. Working closely with community services, our nurse-led service can offer a range of monitoring and treatments.
Our continuous remote monitoring devices can provide 24/7 readings of sats, movement, pulse rate and skin temperature. Patients are supplied with a Samsung tablet to enable video calls, undertake speciality bespoke symptom surveys, and provide direct access to the Virtual Ward hub team.
What does the Virtual Ward offer?
- Daily telephone reviews
- 24-hour remote monitoring using digital technology and responsive dashboard to manage escalations
- Agreed escalation process
- Number of IVs
- Dedicated IV Service covering Plymouth, Kingsbridge, Tavistock, Ivybridge and East Cornwall areas
- 24-hour pump for some TDS and QDS medications
- Dedicated pharmacist support allowing medicine titrations
- Oxygen weaning
- Monitoring and meds titration for fluid overload
- Infection monitoring – obs and efficacy of treatment
- Post op and blood monitoring
- Dedicated community HCAs undertaking bloods and ECGs in the community, along with other tasks
- Attendance at ward rounds
- Attendance to ED/AAU to review patients
- Drafting of all e-discharge/TTAs in preparation for sign off by medical teams
- Liaison with community services (e.g., therapies team, community heart failure, long term conditions, district nurses)
Community Frailty Virtual Ward
The Healthy Lives Partnership (Livewell Southwest and University Hospitals Plymouth) are working together to implement a new Community Frailty Virtual Ward (CFVW) model across Plymouth, West Devon and South Hams. The first locality team ‘Plymouth North’ is now live, with five other teams set to launch in the coming months.
The development of a CFVW builds upon an existing model of integrated community services across Livewell, University Hospitals Plymouth and primary care. It will expand Livewell’s current community frailty team, meaning they will be able to deliver comprehensive geriatric assessments (CGA) at a much larger scale allowing more people to be supported out of the hospitals, under the clinical oversight of the Acute GP service at Derriford Hospital.
An example of a Comprehensive Geriatric Assessment
A CGA will be completed (or updated) as standard as this is evidence-based, best practice to improve outcomes for people with severe/moderate frailty and can reduce unnecessary hospital admissions, lengths of stay and re-admissions.
The assessment includes a physical, functional and psychological assessment, as well as a medication review, optimisation of their long-term conditions, and discussion around advanced care planning. From this, the team will work together to deliver the care, which may include coordination of care and onward referral to other specialist services.
End of life care
In October, we welcomed new colleagues from Marie Curie as we continue to enhance end of life care at the Trust through our Supportive and Palliative Care Service. This is a continuation of strengthening the service after former St Luke’s colleagues joined the trust on 01 October to provide specialist in hospital care.
The Marie Curie Proactive Identification, Care and Transfer Team (PICT) will work with our colleagues to continue the work on improving end of life care with a particular emphasis on identifying patients who are nearing the end of their lives. On identification, the service will look to facilitate discharges to community locations or the dedicated end of life beds at the Mount Gould site, supporting patient wishes and holistic care planning.
One of the aims of our end of life service provision is to increase the number of patients who are supported to die in their preferred place of death and reduce the number of deaths in acute hospital settings. In supporting this, the Marie Curie PICT team will take three forms:
- PICT Team at Derriford Hospital – the team proactively identifying patients approaching end of life and ensure their preferences and wishes are discussed.
- Care Support Team at Mount Gould Hospital – supporting the expansion of end of life beds at Mount Gould hospital. Patients nearing the end of their lives have a higher nursing dependency than those with general rehabilitation and Marie Curie staff will work alongside existing Mount Gould colleagues to provide holistic end of life care and support to patients and families.
- The Care Support Team based in Derriford’s Emergency Department - this element of the service is designed to meet the needs of palliative and end-of-life care patients and their carers who attend the department. We ran this service as a pilot from January of this year, with over 70 people receiving a more dignified and comfortable end-of-life experience in the first 5 months of the service.
How will we measure our success of One Plan?
- 70% 4 hour target
- 70% ambulance handover <15 minutes
- Reduced length of stay
- Reduced delayed discharges
- Better patient experience feedback
