North Middlesex University Hospital NHS Trust

Emergency care was experiencing a 5.5% increase in case load year on year, congestion and difficulties meeting national targets.

The CLEAR project identified the following issues:

  • High volumes of adult walk-in patients (75% of attendances).

New ways of working including:

  • Early identification and movement of frail patients from A&E to specialist assessment.

New models of care:

  • New triage process for adult walk-in cases.
  • Assessment unit for older people.

New models of workforce:

  • Altered nurse shift patterns to match emergency care attendance and occupancy.
  • Multidisciplinary team for frailty.
  • Reduced congestion, improved patient care and safety as a result of early multidisciplinary team working.
  • Improvements in processes and pathways, while using existing staff and estates to deliver more effective care.
  • Increased workforce productivity, improvements in retention and staff experience as a result of using patient-level data to align workforce and activity.
  • Local clinicians empowered to perform service redesign.
  • Potential savings identified as £1.6 million per annum.

“Training is provided through e-learning; didactic teaching from experienced NHS clinicians, managers and data analysts; and close supervision from experienced mentors. In this way the fellows are able to…understand NHS and local trust processes…[and] analyse patient flow and workforce data to put forward innovative ideas and suggest new ways of working. The CLEAR programme also delivers the essential generic skills required by the GMC’s professional capabilities framework to provide safe, effective, high quality care…allowing the Fellows to develop into effective, motivated leaders in their fields in the future.”

Dr Michelle Hayes – Chelsea and Westminster Hospital NHS Foundation Trust, CLEAR Fellow

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