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Meet the team


  • Dr. Varsha Ramakrishnan : Darzi Fellow and Emergency Medicine Registrar
  • Dr. Nnenna Osuji : Medical Director, Deputy Chief Executive and Caldicott Guardian

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

The increased utilization of virtual technology platforms to improve patient care and experience has accelerated during the time of Covid-19. There is a national pilot roll out of a virtual NHS 111 First to directly book patients into an appointment slot in the Urgent Care Center.

We envision supplementing the national ask on the basis of the learning from the initial roll out in Cornwall NHS Foundation Trust with:

1) Geographical Information System Mapping of patient post code Areas that are utilizing this service
2) Understanding Areas of Need and measures to overcome obstacles to access this service
3) Token system within the Emergency Department as a virtual waiting room with real time updates to           patients on their position in the doctor’s queue

What does your project aim to achieve?

Our projects has five main aims:

1) Gaps analysis of Areas of need via GIS mapping of post codes of patients who are unable to access NHS First
2) Streamlining Urgent Care Services to a virtual waiting room on the ED screens
3) Create an educational video to explain trajectory within the ED, 111 First and alternate options both in and Out of Hours (OOH)
4) Create a token system for triaged patients shown in real time on a screen with updates on position in queue
5) Calculate reduced Length of Stay in the ED waiting room secondary to 111 first direct referrals to hospital specialty teams

Croydon University Hospital caters to a diverse and large catchment population. Capturing Areas of Need being missed by 111 First Direct Appointments is the main target of this Quality improvement project.

Another benefit will be reducing crowding in the Emergency Department which is relevant to the Covid-19 social distancing requirements.

How will the project be delivered?

1) Pre and post triage survey of patients with information collected on post code,chief complaints and which pre emergency department services were accessed /contacted prior to hospital contact
2) Understanding need versus demand in the community for NHS 111 First via GIS mapping of post code data
3) Creating a real-time token system for patients physically in the waiting room to see their unique confidential ID numbers move up the queue.
4) Developing a video montage to explain the different areas of ED’s and explaining waiting times, 111 first, Alternative Out of Hour Services and patient trajectories.
5) Staff satisfaction to be measured via qualitative analysis of surveys and Focus Group Discussions.
6) QI methodology of using the tools of “Swim Lane” process mapping to effectively involve all stakeholders to improve service delivery. We will also be utilizing check sheets to understand the bottlenecks to this pilot expansion better.

How is your project going to share learning?

The learning of this project will be shared with the

–Local Quality Improvement and Innovation Hub in Croydon University Hospital
–Local CCG’s
–Quality improvement groups within London
–Q members
–Royal College of Emergency Medicine
–Publish content in journals/peer reviewed articles
–Blogs /Vlogs/ Podcast discussions

How you can contribute

  • Is there existing software to create a token system for patients within the waiting room?
  • Are there care providers who have visual communication templates to explain patient care journeys?
  • What QI measures would further improve the questions we are asking of this intervention?
  • What are the chief ethical concerns that could be posed by this intervention?
  • Has there been any GIS mapping /machine learning interventions for a similar NHS intervention/ service?
  • Could this technique be scaled up rapidly? If yes/no -why?
  • Is there anyone who would like to partner to develop this service within/out of area?
  • Is there a way to virtually communicate when a patient will be seen while maintaining confidentiality?
  • What are the chief concerns that we can envision primary stakeholders that we are involving might have?

Plan timeline

15 Nov 2020 Shared project goal between 111 First, PCN'Ss & the Emergency Department
30 Nov 2020 First round of pilot data collection involving anonymised post codes
31 Dec 2020 GIS mapping differences between pre / post roll out of pilot
1 Jan 2021 Second PDSA cycle to create a "virtuous circle"
15 Jan 2021 Gaps analysis between 1st and 2nd PDSA cycles
30 Jan 2021 Software & funding sourcing complete for virtual waiting room
28 Feb 2021 Month long audit of "virtual waiting room" SMS alert systems
31 Mar 2021 PDSA of 111 first and audit of software complete
1 Apr 2021 Find gaps and revaluate needs for patient demographics missed
31 May 2021 Experience based co-design of staff and patients for new system
15 Jul 2021 Completion of stage 1 PDSA of 111 first & software pilot
30 Jul 2021 Publish results and recommendations for cycle 2 of Quality Improvement Project


  1. This is a great idea; a further thought/extrapolation...

    If you can extract these data to GIS map 111 calls, can you do likewise for 119?  That may allow system wide early awareness of geographies with increased concern of Covid ahead of test results where there are delays in the testing process...

    1. Dear Dr. Sharp, Thanks so much for this comment.

      Looking into the 119 calls we have begun to understood that they are already picking the post codes that are being dialed in from and creating "heat maps". But it may well worth be exploring a bit further to maybe expand on this pilot as a stage 2 prospect. Look forward to hearing your thoughts on this.

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