Testing the ED Capacity Management Guidance document within Hairmyres Hospital

Outcomes

In Hairmyres Hospital, the team use their SOP for managing every patient every time and the hospital barometer daily to identify early signs of pressure in the system. This allows them to monitor and alleviate pressure hotspots within the hospital on a daily basis.

Throughout the month of January, 2016, Hairmyres used the escalation tool daily to monitor the risk of crowding in the ED and alleviate pressure by following their step by step action cards. The result was proactive management of patients with improved patient experience. Prior to this process being in place FCP was seen as an option however, this winter, there was only one occasion when they enacted FCP and moved some pre identified patients to downstream wards where there were no beds currently available. The following day, Hairmyres Management Team met with lead clinicians to debrief steps taken and ensure that no patients had come to harm. Additionally, the team reviewed all actions to ensure no alternatives had been averted.

Managerial and clinical staff have commented that although winter was challenging this year, having the refined SOP, step by step guidance and clear escalation plans and action cards to follow has meant it felt safer than years previous:

"There was one particular week in January where we could see the pressure building but it felt more planned. Knowing the step by step guidance is there is reassuring as a Duty Manager. We have a structured process to follow to avoid the department becoming crowded, as well as a structure to de-escalate and avoid having to go to FCP."
(Graham Simpson, Duty Manager)

"Along with other improvements we have made such as daily huddles and our daily 'onion' (newsletter), the process of working through the ED Capacity Management Guidance has helped us to create a sense of shared responsibility across the organisation. It has challenged perceptions that ED causes problems elsewhere in the system by promoting conversations across hospital teams and providing a structured way to provide an awareness of the whole hospital and how teams can support each other. This work has also allowed us to define what we mean by overcrowding and overcapacity and develop measures and a tool to identify triggers, meaning we can escalate and take immediate action. It has provided a structure to manage crowding in a way that we didn't do so before. Having a structure means that we can not only eliminate crowding when it happens, but we proactively predict and escalate before we become crowded."
(Karen Morrow, Service Improvement Manager)

"It has given us a structure and a process to follow that is standardised. This Winter felt very different to last year; it felt safer."
(Neil Ferguson, Duty Manager)