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Urgent care doctor praises Sherwood Forest Hospitals’ Emergency Department turnaround


 Emergency Care

Staff throughout Sherwood Forest Hospitals Trust have worked to help urgent and emergency care hit the four-hour target


Sherwood Forest Hospitals’ leading urgent care medic has praised staff throughout King’s Mill Hospital for the part they have played in transforming the Trust’s Emergency Department from one of the poorest performing to, consistently, one of the best in the country.

For the three months ending 31 September, the Trust achieved the national target of seeing and treating 95% of urgent admissions within four hours.

This puts Sherwood Forest Hospitals among the top 30 performing in the country for the four-hour target. In contrast to this, in December 2014 the Trust was seeing 86% of patients within four hours and was fifth from bottom among England’s 136 Trusts offering an emergency department service.

Consultant Dr Ben Owens, clinical director of the Trust’s urgent and emergency care division, said that although the four-hour target focussed on emergency departments, in order to achieve performance the whole hospital has to work effectively and efficiently.

“It also means we have to have in place effective arrangements with partners to prevent avoidable emergency admissions and discharge people from hospital efficiently when they are ready to leave.

“This successful turnaround is therefore an indication of the whole Trust’s performance including our Emergency Department, as well as of effective working arrangements in place with health and care partners.

Speaking ahead of Sherwood Forest Hospitals NHS Foundation Trust’s monthly board meeting on November 2, where he is due to update the Board with details of the transformation, Dr Owens said: “The four-hour target for emergency departments illustrates that staff across the Trust are getting things right.

“If we are to cope with emergency admissions, patients need to be flowing efficiently through the whole hospital system – getting better and being discharged safely back home.

“Staff in the Emergency Department deserve great credit for the way they are communicating with all parts of the hospital to improve patient care.

“If a hospital isn’t dealing efficiently with all its patients, peaks in the number of cases being dealt with by urgent care teams can result in patients having to wait in corridors to be transferred to wards, in our waiting areas or even in ambulances.

“The four-hour target attracts so much attention because it indicates how well the whole hospital and Trust is performing, as well how effective are the working arrangements we have in place with health and care partners.”

Dr Owens said the strong performance had continued into October with the Trust treating 96% of admissions within the four-hour target               . 

In response to the Care Quality Commission (CQC) inspection in 2015, the Trust implemented a quality improvement programme. CQC inspectors returned in July this year to investigate the particular areas requiring improvement, and informal feedback following the visit was positive. The formal report is expected to be published in the next month.

Dr Owens, who is also the urgent and emergency care clinical lead for the Midlands and East region for NHS Improvement, pointed to a number of other indicators where the Trust is now “getting things right” and, in many cases, demonstrating best practice. These exemplify the significant improvement achieved over the past year in terms of quality, safety and performance, and include:

Infection control: Cases of C. Difficile infections have been reduced by a third each year for the past two years. There have been no recorded cases of MRSA bacteraemia blood infections for 15 months.

Sepsis: We are among the top 30 best-performing trusts for the management and screening of the potentially fatal condition sepsis

HMSR: The Trust’s Hospitalised Standardised Mortality Ratio (HSMR) – the way hospitals measure mortality for the 12 months to July is 94. The HSMR gives a score for each hospital, taking into account the health of the local population. Anything below 100 is better than expected.

Length of stay: The average time spent in hospital by patients during the 2014-2015 financial year was 7.73 days. During the 12 months to April 2016 the length of stay was down to 6.45 days and during September this year the length of stay was 6.07 days.

Managing patients at risk of cardiac arrest: The number of people suffering cardiac arrests while in Trust hospitals is now down from three patients per 1,000 in July 2013 to the national average of 1.8 per 1,000 patients.