Three changes every Emergency Department should think about making

Placing senior staff at the heart of triage within Emergency Departments (EDs) and empowering them to make autonomous decisions quickly and accurately can help NHS trusts hit their national targets.

Effective triage using senior staff

The national standards for emergency care were established in the early 2000s to provide the public with clear expectations for services, particularly around the crucial four-hour discharge target in A&E.

“When we did an original analysis for all presentations, only 0.5% of patients needed to be in A&E for more than four hours”, says Jane.

This complexity arises from the fact that emergency departments are often inundated with patients who might not require emergency care, reflecting a misuse of resources similar to calling the fire brigade for a cat in a tree.

Jane’s belief is that effective triage is a critical component in managing these challenges. Senior staff, with their extensive experience and ability to quickly discern patient needs, can streamline the triaging process which reduces delays and ensures patients are directed appropriately. “The more senior the staff in the triage are, the more effective the pathway,” Jane notes.

Improving process design to empower human talent can significantly enhance the triaging and treatment of care, ensuring that emergency patients receive the right care at the right time.

“The challenge of the four-hour target is immense because it’s not just the responsibility of the emergency department; it’s the whole system that needs to work together.” Jane Ansell, principal consultant at Pace, says, who believes that making three simple changes to roles and responsibilities within an ED can make all the difference.

Three things an ED can do to empower autonomous decision making to get achieve national targets:

Jane believes that three steps can move trusts a long way to achieving targets. Firstly, the creation of a senior triage officer, then the creation of a flow manager role and then ensure all processes route through those roles to maximise the potential of human autonomous decision making supported by systems.

1. Senior Triage Officer: “One of the first things I would recommend working on is looking at the skill mix of an ED and matching that to the cohort of patients and their presentation,” Jane says. This approach ensures that those with the highest skill level handle the most critical initial assessments, drastically improving patient outcomes.
2. Flow Manager: “Redesigning, or creating the role of a “flow manager, to emphasise its importance can significantly improve operational efficiency” comments Jane. This role, often undervalued, is crucial for managing the movement of patients through the system. “What you need is a team member who absolutely understands what it is to coordinate across various demands, much like managing a family of six with competing priorities,” Jane explains. By recognising and resourcing this role appropriately, healthcare systems can ensure that patient flow is managed effectively, preventing bottlenecks and ensuring timely care.
3. Ensure all clinical and operational pathways and processes come together for these two roles, which is essential for maintaining a seamless patient journey. The operational pathway must complement the clinical pathway to ensure that patients move efficiently through the system. This requires rigorous data analysis, robust communication and coordination among all departments. “The responsibility of every receiving department inside the hospital is to make provision and capacity for what they know to be the presenting population health need,” Jane highlights. By forecasting and preparing for patient inflows, departments can better manage their resources and maintain compliance with national standards.
   

Conclusion

Improving process design to enable human talent to make autonomous decisions is a vital step in enhancing emergency care. By placing experienced staff in key roles and redesigning operational processes, healthcare systems can better manage patient flow and ensure timely, effective care. This approach not only helps in meeting national standards but also ensures that patients receive the highest quality of care when they need it most. As Jane aptly puts it, “The four-hour target is not just an emergency department measure; it belongs to every service that supports integrated emergency care” Empowering human talent through better process design is the key to achieving this collective responsibility.

However, as our understanding of healthcare dynamics evolves, it becomes evident that meeting these standards requires a more holistic approach involving the entire healthcare system, not just the emergency department. Jane’s advice here is that it all begins by analysing the population’s needs, and the frequency of injuries and illness, healthcare providers can allocate senior resources when and where they are most needed. From this systems and process can be designed to suit.