We successfully improved patient flow efficiency in five acute and community trusts, achieving zero ambulance delays, reducing handover times, and implementing timely crew shift completions through data-driven strategies and on-site support.

Background

The Northern Ireland National Health Board brought in NHS Midlands and Lancashire’s Nursing and Urgent Care Team (NUCT) to increase patient flow efficiency in five acute and community trusts. 

Action

NUCT deployed data and analysis to devise innovative strategies that resulted in tangible improvements. The following was undertaken by the team:

• clinical and operational guidance offered, pinpointing recurring issues, and creating cross-pathway solutions to system hurdles.
• consideration of the entire patient journey and prioritised specific pathways to enhance patient flow.
• advocation for a “pull” model for discharge, ensuring appropriate community support was available.
• resource allocation was optimised by analysing post-discharge service consumption and long-term care utilisation.
• monitoring discharge destinations and pathways evaluated process effectiveness.
• risk thresholds balanced patient safety and resource utilisation.
• real-time visibility of demand, capacity, and flow was emphasised which allowed for streamlining processes resulting in improved efficiency, and strengthening out-of-hospital services reduced strain on acute care whilst tracking key metrics supported progress monitoring.

These strategies aimed to address issues and enhance patient care. Over three days per trust, the team worked with clinical and operational teams, offering real-time information support for crucial decision-making. Senior nurses assumed coaching roles to improve patient flow in emergency departments, wards, and discharge pathways, advocating a uniform approach to demand and capacity management across hospital and community teams.

Impact

The team achieved zero ambulance delays, improved handover times, and timely crew shift completions through on-site presence. They set up hospital operation centres that used data to create an actionable unified view for decision-making. 

By increasing early discharges and utilising discharge lounge capacity, hospital flow started three hours earlier daily, resulting in aligning capacity with demand and preventing delays. 

Every cooperative action led to enhanced safety and patient outcomes, demonstrating that quality care goes beyond merely meeting targets. NUCT also collaborated with trust staff, recognising the necessary culture shift for the safe and successful implementation of change. They managed out-of-hospital information flows, speeding up hospital discharges and reducing unnecessary stays.

Feedback

Their contribution was excellent. Their expert, patient-focused challenge and support enabled the team to reflect on issues differently and to introduce improvements in practices and processes which remain in place today.

Executive Director of Nursing, Midwifery, AHPs and Patient Experience| South Eastern Health and Social Care Trust