Changes to the Emergency Department
Interviewee: Dr Kay Stenton, The Rotherham NHS Foundation Trust
Steps were put in place to reduce footfall through the Emergency Department (ED) in The Rotherham Hospital NHS Foundation Trust (RHFT), whilst still providing people with the necessary care and advice dependant on their presentation to ED.
RHFT has an urgent and emergency care centre which integrates the ED with a walk-in centre. A clinician, such as a GP, would then screen everyone at the door to assess whether admittance to ED was the most appropriate action. Signposting to other services, such as pharmacies for advice and self-care at home, was also provided.
It became clear that to reduce footfall in ED, the layout of the area had to be amended. As part of important adjustments to ensure stringent infection control measures, the hospital had to ensure the separation of patients presenting with potential respiratory issues from others who may pose a risk to their condition. The Orthopaedic Department, located next to the ED, was treating minor injuries. Orthopaedic services were also stopped as it had a separate entranceway and this reduced the number of people entering ED. Similarly, appropriate paediatric cases were triaged to ensure they were directed to the Paediatric Ward as appropriate.
At the peak of COVID-19, the hospital saw a 50% reduction in ED attendances. Staffed by clinicians and GPs, the triage system in ED ensured that visitors to the department were appropriately assessed and cases managed based on clinical need. For visitors not admitted to ED, other resolutions involved signposting as appropriate to other wards, health services or suitably resolved without further need for clinical intervention. .
Feedback about the triage system proved valuable and has been well received by the public. Visitors that were asked to participate in the survey were satisfied that they had consulted a clinical professional and received appropriate support.
The suspension of some services, such as elective surgery, also enabled the expansion of additional facilities to support social distancing and separation of respiratory (and non-respiratory) patients. The reallocation of staff, who would otherwise have been working on these closed wards, supported this infection control activity. With services restarting, there are ongoing challenges to manage to the hospital site to maintain safe distancing, but this is carefully resolved through stringent infection control processes.
In the SYB ICS, the Urgent and Emergency Care Network (UEC) are exploring how some of the changes made across ED departments can be embedded across the system, including minor injuries. Business cases are being considered and put forward, yet workforce and estates considerations are potentially limiting factors when considered in the round.
The UEC group and YAS are looking to have clinical access provided via ambulatory care. This will enable healthcare workers to assess patients and make recommendations for alternatives to ED, or provide relevant care to remove ED as a step entirely.
Key Learning Points
The use of clinicians to triage at the door has been well received by the public and enabled the reduction of footfall into ED.
It is important to get all stakeholders in a patient pathway on board to ensure champions of the change throughout and reduce challenge.
Strong business cases include workforce considerations, estates and the associated costs. By not considering these, it can be challenging for people to remain positive when things start to fall over. Robust plans are needed to address teething issues and mitigate risks early.