Croydon Health Services has one of the busiest emergency departments (ED) in south west London. On a performance level we had been struggling to meet the 95 per cent Emergency Access Target for some time. In May 2015 we put in place an emergency care recovery programme with a number of workstreams, one of which focused on patient flow.
In a recent HSJ article I explained how Beautiful Information dashboards and modelling tools helped shape and support the redesign work of our new front-end model of care. Throughout this programme we recognised the need for real-time information to help us manage changes to services and their impact on patients.
Having analysed the patient journey, from admission through to discharge and across the health economy, we had a much better understanding of patient flow. Our analysis demonstrated that all medical patients were being admitted to the acute medical unit (AMU) as a priority from ED to be assessed. Typically, these patients would be admitted to be assessed as an inpatient (albeit short stay) rather than assessed in an appropriate consultant-led ambulant type setting and more appropriate outpatient environment. In addition, transfers out of AMU typically would occur late in the day, with increased risk of additional complications.
Our new approach to emergency care was based on a clinical vision which we were able to model following an extensive analysis of patient flow data through accident and emergency and downstream. Our analysis looked at data over 18 months to highlight what needed to change and demonstrate the rationale. It helped to show us what capacity was needed, the bed reconfiguration requirements moving forward as well as predicting the impact of these changes. We developed a bespoke version of the smartphone app Operational Control Centre in order monitor performance and support the changes being driven through.
This included a radical redesign of the front-end model of care co-locating acute assessment, ambulatory and comprehensive geriatric care services under one umbrella and in one single environment. Community and mental health services were also incorporated creating a first-of-its kind unit with one-stop consultant high quality care.
The result was the Edgecombe Unit which opened in November 2015. The unit now sees over 2,000 patients per month; of these, two thirds would have previously been admitted via the emergency department, incurring delays in assessment and potential subsequent admission. Instead the Edgecombe Unit has reduced the length of time patients spend undergoing assessment and waiting for medical review and there is faster access to a specialty bed where needed. Most importantly, patients are now admitted purely on clinical need, not operational pressure. Since the unit was opened the reduction in number of admissions has fallen by over 20 per cent compared to the same period the previous year.