Same Day Emergency Care Glangwili Hospital

Understanding the Problem

Same day emergency care have been successful in preventing avoidable hospital admissions in urgent care centres across the United Kingdom. However the utilisation and scope for SDEC in Glangwili General Hospital has not been fully optimised with only 5% of emergency attendances managed through this pathway whilst the national ambition is around 30%.

Measures: How will we know a change is an improvement?

The following measurements were agreed with historic baseline data pulled for the 10 weeks prior to the project commencing

The Theory of Constraints, data represented in the Pareto chart and Cause and Effect (fishbone) diagrams were used with the project team and wider stakeholders to understand the problem and identify the potential change ideas represented in the driver diagram below.

Changes: What changes can we make that will result in and improvement?

The project tested multiple change ideas identified by the project team and wider stakeholders in brainstorming meetings, process mapping and fishbone diagrams.

PDSA 1: Change the door of the unit to stop patients in beds being put in the unit. Adopt –learning: Stopped beds going into the unit but did not increase the number of patients going through the unit or aid identification of patients suitable for SDEC. Next steps to include: Testing a triage tool (AMB Score).

Improving SDEC flow will address key components of the 6 Domains of Quality in Healthcare:

Timely – patients will be assessed, treated and discharged on the day of presentation

Efficient & Effective – increasing flow through SDEC will reduce admission >24hours, releasing bed capacity and improving waiting times

Safety – reducing admissions >24 hours will minimise the potential for hospital acquired infections and deconditioning

Patient Centred – SDEC considers the individual needs and preferences of patients as well as the wishes of their families and carers

Involving others

The project team: Senior Sister ED, Staff Nurse CDU, Advanced Nurse Practitioner, Consultant Acute Physician, Physiotherapist, Occupational Therapist, Improvement and Transformation Lead and Quality Improvement and Service Transformation Practitioners.

A Stakeholder analysis exercise and fishbone diagram was used to identify other individuals and groups that would be key to the success of the project.

Engagement consisted of:

Regular meetings with the wider MDT/informatics/analysts

GP cluster meetings

QI collaborative team meetings

SDEC/CDU meetings with clinicians and managers

Staff survey and feedback

Co-producing patient posters and leaflets

The SDEC project is a co-design between partners- testing ideas and developing a model for SDEC together as equals.

Aim: What are we trying to accomplish?

To improve the number of patients managed through SDEC by 20% by March 2020

PDSA 14 Ramp 1: Multiple PDSA’s within 1 week. Rapid learning with Adopt, Adapt or Abandon approach. Learning: Ring fencing SDEC is key to enable full utilisation, G admissions alone are not enough, needs pull from the emergency department and need to explore WAST pathways.

Reflection and the next steps

Lessons Learned:

• Ring fencing SDEC is key

• Triage tool for SDEC (AMB Score) accurate in predicting same day care