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