A hospital boss today told a radical rethink of emergency care led to its A&Es becoming the quickest in London at treating patients.
Epsom and St Helier NHS trust pioneered new systems to get patients home as soon as possible after running out of beds during the 2015/16 winter.
The results, which surprised even its own staff, saw it deliver the seventh best A&E performance in the country in January and achieve the NHS target of treating 95 per cent of patients within four hours for the entire 2016/17 year.
Its approach could provide a solution to the growing NHS crisis in preventing patients who are also dependent on social care from getting stuck in hospital.
It could also offer a lifeline to a trust struggling with buildings at St Helier that date to 1937, and which is at risk of losing out in a proposed shake-up of A&Es in south-west London.
Chief executive Daniel Elkeles (above) said: “About this time last winter, we ran out of space. We decided to completely rethink the emergency care pathway. There was no more space at either Epsom or St Helier to admit people.
“It was either build some more capacity – for which there was no money – or this. Everybody knows that there are patients in the hospital for whom it is no longer appropriate for them to still be here.”
Under the patient flow transformation programme, hospital leaders meet at 9am, 11am and 3pm to assess the status of every inpatient in their care.
Mr Elkeles said: “The objective is: what do we need to do for this patient today so that we can get them home? You end up with an agreed action list for each of these patients.
“In 20 minutes we go through the entire hospital, knowing who is definitely going home today, and who could be going home today if we did X, Y and Z. [The key thing] is that we have all the people who can make X, Y and Z happen in the room.
“If you join up everything we are doing, we have as good an emergency care pathway as you can provide in the UK.”
By improving patient flow, the trust has freed-up beds – meaning it has not had to cancel an operation since last October for urgent care or cancer patients.
In addition, it is saving up to £2 million a year by no longer having to send patients waiting too long for surgery to private hospitals.
At St Helier, a 22-bed “step closer to home” ward has been established for patients who are medically ready to leave but who cannot quickly return home, often due to a lack of carers or because they require neuro-rehabilitation.
At Epsom, an “at home” service sees medics and council social services teams assess patients together and provide full support for their first 72 hours back home. Dr Guan Lim, clinical director for medicine at Epsom, said: “It’s a real game-changer in how we provide this care.”
The entire trust is said to have “bought into” the four-hour A&E target, rather than just seeing it as the emergency department’s concern. An ambulatory care centre aims to treat and discharge patients referred from GPs within a day.
Amir Hassan, lead emergency consultant, said the key to coping with new patients was ensuring the swift treatment and discharge of existing patients.
“Everyone says we are understaffed and under-resourced,” he said. “The reason why we are under-staffed and under-resourced is because we are dealing with too many patients sitting in A&E without being moved on.”
Dr Simon Winn, clinical lead of the acute medical unit, said: “If they don’t need to be in hospital, we should be doing everything we can to facilitate them to leave.”
- An edited version of this article appears in tonight’s Evening Standard.