Case study: Implementation of Senior Doctor Triage (STD) NIHR CLAHRC YH Theme: AAA

March 2015

Contact: [email protected]

Background: The Avoidable Attendances and Admissions (AAA) Theme, in collaboration with the Academic Health Sciences Network Yorkshire and Humber (AHSN YH) successfully engaged with all acute hospital trusts in the region to identify and disseminate best practice to improve the speed and appropriateness of treatment (triage) in emergency departments. More specifically, focusing on methods such as senior doctor triage. SDT is an evidence-based process of care which cuts patient waiting times in Emergency Departments (ED) and reduces admissions and length of stay in hospital. It therefore has the potential to produce cost savings for the NHS. Improving the implementation of this intervention in Yorkshire and Humber (EDs) is a key focus of this joint work between AHSN and the CLAHRC. The project has instigated successful engagement of all acute hospital trusts in the region, and supports two trusts (York and Leeds) to take a leadership role alongside the study team. The study has involved a survey of all trusts to understand what patient processes are in place on arrival in the ED, and understand the variation in practice across the region. Thirteen of the 14 acute trusts have completed this mapping exercise, which has not been undertaken before on such a large scale. This provides a comprehensive understanding of how EDs are achieving successful patient care outcomes (such as reduced waiting times) and allow further detailed study of those EDs that currently operate different forms of SDT. A learning event workshop has been used to disseminate the findings of the survey mapping. The event also provided round-table discussions with ED clinicians and allied health professionals from across the region to discuss how SDT can be implemented and improved to form a sustainable process for treating patients. The next stage (phase 2) of the study will involve further detailed study of EDs operating different models of triage (for example senior doctor led versus nurse-led) likely to include up to 2 hospital sites. This will commence next year, and will include mapping the patient journey through the ED to identify where improvements in the process can be made. Patient views on their experiences and preferences will also be collected. Working with the ED staff, the identified improvements will then be implemented into clinical practice with key performance measured before and after implementation. Phase 2 is expected to last 12 months, allowing for development (3 months), implementation (4-6 months) and measurement (3 months). This project will directly influence practice and healthcare provision in selected EDs based on a thorough understanding of the processes of SDT that have a positive impact on patient care. It will then use this information to improve dissemination of this evidence into practice using a consensus conference approach alongside service configuration documentation. This work will also have the potential to advance an understanding of methodologies to improve the implementation of evidence www.clahrc-yh.nihr.ac.uk

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based interventions into complex and pressured emergency and urgent care system providers. Resource use / potential saving of resources will be part of this work. An economic evaluation of the cost/benefits of clinically effective methods of SDT will also be undertaken to assess if the clinical benefits are translated into resource saving.

Next steps: The study is at the stage of identifying trusts to carry out more detailed work beginning with the process of mapping the patient journey through the ED with an aim of identifying key features of the models of triage (SDT, nurse-led, etc) which can then be improved. A briefing paper is being finalised detailing both the patient processes currently in place on arrival in the ED, and the variation in practice across the region which will be disseminated via future theme workshops and site visits. Further evidence reviews detailing key service improvements from senior doctor triage processed will be produced and these will be shared on the ‘actionable tools’ area of the CLAHRC YH website. A cost effectiveness analysis will be undertaken in collaboration with the Health Economics Theme to identify cost implications of service improvements around SDT.

How CLAHRC supports this project: The contribution of the CLAHRC YH in collaboration with the AHSN YH has been crucial in developing the partnerships between the research team and the acute trusts to establish this study. The Avoidable Attendances and Admissions Theme established the initial links with the AHSN YH via the AHSN Improvement Academy. A close working relationship between the AAA theme and the Improvement Academy has allowed existing intelligence of potential partners and contacts to be developed in order to establish this study successfully across the region.

Provided for i.e NIHR Annual Progress Report March 2015 The NIHR CLAHRC Yorkshire and Humber is a partnership between 31 organisations including NHS, Higher Education, Local Authorities, Charities, Industry and the Regional Innovation Hub. A full list is available on our website www.clahrcyh.nihr.ac.uk

www.clahrc-yh.nihr.ac.uk

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