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26th May 2021

Wales Emergency Department Experimental Measures: 6 Months On

Background:

Historically one of the few ways to measure Emergency Department performance was to look at the 4 & 12 hour targets. The key challenge here is it doesn’t give any valuable information other than how quickly the patient journey was through the Emergency Department, which creates a challenge when trying to look at improvement and transformation as well as patient experience.

Project Opportunity / Aim:

As part of the Emergency Department Quality & Delivery Framework (EDQDF) programme the Pioneering KPI’s also known as the Emergency Department Experimental Measures aim to show the bigger picture of the patient journey through an Emergency Department. These experimental measures look beyond the current 4 & 12 hour targets, breaking down the various touch points of the patient journey alongside triage score to help inform positive system transformation to improve resource and patient experience.

 

Key Objectives:

  • Engage local health boards informatics teams, Clinical Directors and Communications teams
  • Implement the first three measures across local health board Emergency Departments
  • Increase data quality and completion locally
  • Publish Top 3 Measures nationally
  • Align and support Urgent & Emergency Care 6 Policy Goals
  • Enable Health Boards to start to ‘changing their conversation’ about quality improvement projects supporting patients care in the Emergency Department

 

 

Work to date Nov 2020- May 2021

The central team have worked across a variety of areas to drive this piece of work, including:

 

Engagement:

The programme team have successfully worked to engage with a variety of key stakeholders to carry out this piece of work. These stakeholders include:

  • Emergency Department Clinical Directors
  • Health Board Informatics Teams
  • Communications Teams
  • Digital health Care Wales
  • Stats Wales

Communications:

The communications team developed a multiphase communications approach with a simplistic story telling approach to launch the measures which included:

  • A national health board stakeholder toolkit for both internal and external communication use to help highlight benefits of the work to staff
  • National Media Launch
    • BBC
    • ITV
    • BMJ
  • Ministerial Statement from Welsh Government
  • Monthly National Publication on NCCU Website

 

Data Development:

To continue the development of the work the central team continue to undertake:

  • Monthly data reviews with health board informatics teams to continue local data improvement plans
  • Monthly data improvement meetings with Digital Health Care Wales (DHCW)

The below table demonstrates the data improvement work carried out during the last 6 months:

Current Position:

The published experimental measures looked at the national median across the Emergency Departments in Wales. The measures looked at Time to Triage, Time to a Clinician and patient outcome which at this stage looked at percentage of patients that required no further outcome past the Emergency Department. Below is a breakdown of the three experimental measures showing the national picture for the last six months:

 

Next Steps:

For the next phase of the work we aim to:

  • Implement further measures
  • Publicise the 3 measures by Emergency Department
  • Follow on communications and media to support updates
  • Pilot a bespoke Emergency Department escalation tool to reflect staffing and crowding in Emergency Departments
  • Develop internal professional standards to reflect time of referral and time seen by a specialty
  • Health Service Research Presentation to promote the work

 

Comments from the Central Team:

“Developing the experimental measures has given us many challenges to overcome but just as important has given us good foundations and networking opportunities to develop further measures in the future. The trends in the data is reflecting the fact that ED’s are getting busier with more attendances than pre coved in some. The data can be used to help inform whether the right staffing are in right place within the ED””

Dr Jo Mower, Clinical Director, National Programme for Urgent & Emergency Care

“Positive system transformation like this is complex, within our work we have brought together a variety of organisations across Wales to collaborate in the development and implementation of the Pioneering KPIs. It is our ambition in an ever changing world to be able to provide our Emergency Departments with the right tools to be able to drive positive transformation, make informed decisions based on a variety of data and improve the outcomes and experience of their patients. Although there is still a way to go, we are thankful of those that have entered this journey with us, and look forward to continuing this piece of work”.

Julian Baker, Director of National Collaborative Commissioning, National Programme for Urgent & Emergency Care

“We have a vision of tomorrow that is much more innovative and collaborative putting the patient front and centre by linking data. As we work collaboratively with Informatics teams across organisations in Wales we can then provide health boards the linked data required to view the patient journey from point of contact, their journey through the Urgent and Emergency Care system and through to discharge. Using data to inform transformation of the emergency care system”.

Ricky Thomas, Head of Informatics, National Collaborative Commissioning Unit

“For many years the conversation with both the public and media of Emergency Departments have revolved around the 4 & 12 hour targets. These new measures are a major driving force in changing that conversation, to show the real picture beyond 4 & 12 hours. The multi communications approach ensures we take both staff and patients on this journey of positive change. Putting the patient at the centre of the work, to help improve their experience and outcomes, demonstrating there is more to their experience than if they have waited more than 4 hours”.

Scott Wilson-Evans, National Communications Manager, National Programme for Urgent & Emergency Care

 

ENDS

 

For further information please visit: https://nccu.nhs.wales/urgent-and-emergency-care/experimental-kpis/ or email Scott.Wilson-Evans@wales.nhs.uk.