Improvements in our Emergency Department

Local improvements to support urgent and emergency care

The NHS and community services continue to experience high levels of demand. Here at the Royal, patient safety remains our first priority and emergency care is provided in a variety of ways - in hospitals, walk-in centres and urgent care settings.

Those with serious or life threatening conditions will always take priority and are seen quickly. Other patients with less serious conditions may wait longer for treatment.

We have made significant improvements across the region including reducing the time it takes to get ambulance crews back on the road once they have been brought to the emergency department at the Royal. These are now some of the fastest turnaround times in the region.

We continue to work with community and social care partners to improve how we work more cohesively for the benefit of our patients and to prepare for this winter. This will help us to ensure patients receive the right care, in the right place at the right time.

We are introducing measures to avoid patients being admitted to hospital if they don’t need to be, reduce the time patients spend in hospital, enable them to be discharged home sooner and improve the flow of patients through our hospitals. These measures will help reduce the numbers of patients waiting longer than four hours in emergency departments. 

For example:

  • In the emergency department new measures are being implemented to redirect patients with non-urgent conditions to a more appropriate alternative such as GP out of Hours, pharmacy or a walk in centre. 
  • We are extending our localised rapid response community teams to see vulnerable elderly patients in their place of residence (care or nursing home), and possibly avoid the need to go to A&E.
  • We have conducted a pilot in ambulatory care which involves treating a significant number of emergency patients that can be managed safely and appropriately on the same day without admission to a hospital in-patient bed. This takes place in a designated area of the acute medical unit (AMU). The area also allows patients to begin treatment in an appropriate environment while waiting for a hospital bed to become available if they do need to be admitted. This pilot has been hugely successful with some of our patients’ length of stay being reduced from days to hours, meaning they can go home much sooner. 
  • We have also opened a clinical decisions unit (CDU) which is an area specifically designed for patients who are awaiting a decision on their treatment, enabling their bed to be used by other seriously ill patients once they have been assessed. The eight-bed-unit, which opened in June, has eight chairs, two trolleys and replaces the current observation unit. It’s managed on a daily basis by the Emergency Department coordinator and medical controller, with patients only being accepted by a senior clinician. The unit will improve patient experience – both for the patient who is waiting for the decision, and the patient who is waiting to be seen in our Emergency Department.
  • We have relocated the frailty service at the Royal closer to the emergency department assess older patients quicker and to reduce unnecessary time spent in hospital.
  • We are also working with GPs and community nurses to provide quicker assessments and care in the community for those patients who no longer need to be in hospital.
  • Hospitals are implementing measures to standardise care on the wards, which aims to improve the journey through the hospital for our patients streamlining their care and prevent unnecessary waiting for patients.

As always we are also asking the public to think carefully about which health service they require when they are unwell and to keep emergency departments free for those who really need it. Our message to them is examine your options. If you have a non-urgent health problem, please consider other services such as walk in centres, GP out of hours, pharmacies or NHS 111 

As a Trust we would like to thank all those working hard to provide high quality care in the best interests of our patients.