What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

In our acute hospital the patients presenting to the Emergency Department (ED) are streamed by Urgent Treatment Centre (UTC) staff to decide whether they should be seen in the ED or UTC. This can lead to excessive queues (bottle-necking) in one stream or another at different times of the day. Because the providers are different there are conflicting motivators for staff at different points of the process. The objective is to re-focus the process on the patient (in terms of experience and quality) and ensure that they are able to get to the right practitioner first time. In addition, front-loading of investigations (where capacity allows) would ensure that the overall time that the patient spends in the UTC/ED is kept to a minimum. A hard to navigate service will disadvantage those patients who need our service the most and the objective is to break down some built-in inequalities of access.

What does your project aim to achieve?

The objective is to ensure that all patients are treated fairly and effectively if presenting to the UTC/ED. At present there are various confounding factors that impact on patient flow, including staffing levels in the streaming team, sometimes behaviours in one part of the team or another, and also the “behind the scenes” activities within each service. This project aims to break through these and re-focus attention on the patient. One objective is to design a responsive UTC/ED initial assessment process that delivers really high quality and consistent assessment process, and to learn from and design out current blocks that prevent us from doing the right thing for all our patients.

How will the project be delivered?

The project will be a collaborative improvement project. We will involve the entire front door team and ensure that all voices and opinions contribute. Another key part of the process will involve harnessing the opinion of the patient, and we will ensure that there is a patient-based focus group to inform and support change.

The resource will be invested in a full time project lead who will have a “day job” role as a member of the initial assessment team. They will be tasked with running the improvement project and bringing the team together. We will need to ascertain which activities add value to the patient journey, and which do not. The team will design the monitoring and measurement techniques to ensure that we demonstrate improvement against pre-determined standards, in particular time to see clinician, time to resolution of treatment, reduction in number of service moves and patient experience.

How is your project going to share learning?

There are likely to be opportunities to produce evidence of success and improvement by presentations (including in poster format) at conferences (eg Royal College of Emergency Medicine Annual Scientific Conference). It is also likely to be effective in sharing this via social media and other less traditional methods of dissemination.