Case study
Last year, King's College Hospital NHS Trust sustained its good performance in emergency care throughout the winter period. Liz Wells, head of emergency planning and clinical site management, talks about measures they put in place to cope with winter pressures
King's developed and agreed a winter planning strategy for 2004-2005 at the start of October 2004, in partnership with our local strategic health authority, primary care trust (PCT) and social services. All care groups submitted their plans for co-ordination by the clinical site management team and regular meetings were established to facilitate escalation via social services for any increase in the number of delayed transfers of care.
At that stage, robust, tried and tested policies of escalation designed to deal with surges of emergency admissions via A&E were already in place. The hospital recognised that capacity planning and escalation were year-round issues for balancing elective and emergency work, depending upon waiting list and emergency care performance. Regular reviews of bed availability were already in place and changed at points throughout the year to accommodate and reflect the varying patterns of demand of contracts, activity, waiting times and emergency needs. Daily bed meetings continued throughout winter to balance emergency and elective patients' needs.
The trust's co-ordinated flexible bed plan was extended to cover the holiday period and early into the new year to ensure that emergency access was maintained throughout and that elective work came back on line quickly after the holiday.
Our trust worked very closely with the PCT to link care processes more effectively with primary care. The PCT's Patient Advice and Liaison Service and primary care nurse practitioners' presence within the A&E led to a greater understanding of reasons for A&E attendance. One common reason involved patients with English as a second language who had not been able to register with a GP. These patients could then be registered within the emergency department and appointments for the GP surgery were made on their behalf.
At the time, King's College's biggest risk was probably that of rising mental health patient attendances, coupled with major bed problems at the partner organisation. A working group comprising King's and the local mental health institute was established to develop and agree strategies to address these concerns. Psychiatric liaison nurse services were made available 24/7 within the A&E, enabling early decisions and implementation of the care plan, using community health teams where appropriate.
Cover for executive and general management annual leave was co-ordinated by the director of operations and nursing, while normal senior management cover continued throughout. The 24-hour on-call arrangements were also installed and daily reporting via SITREPS (situation reports) also continued throughout the period.
All trust staff were offered a flu vaccination and data was routinely collected to predict the impact of weather on the health of the nation in conjunction with the Met Office. Working closely with the infection team, timely reporting and investigations resulted in early decision-making to control the spread of infection.
King's is now in the process of planning for winter 2005 and even greater use of the trust-wide predictor tool will be used to understand emergency admission flows to develop strategies that address these needs.
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