Emergency departments nationwide are dealing with unparalleled pressure, resulting in prolonged waiting times for patients in A&E and an unacceptable rise of patients receiving their care on a corridor. This strain not only jeopardises patient outcomes – a clear association has been shown between length of stay and patient outcomes – but also intensifies the challenges faced by our dedicated healthcare staff.
In response, at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) we are spearheading a digital revolution and prioritising patient flow in the process. We recognise the imperative for innovative solutions to enhance patient care and streamline operations.
Continuing to digitally transform to improve patient flow is a top priority for us this year, and is underpinned by an important, strategic implementation of Altera Digital Health’s patient flow technology. As the first NHS trust to implement the solution, it is a key component of our Digital Transformation Strategy.
Patient flow is an issue that can sometimes be overlooked but improving it will have a major impact on improving patient care, staff experience, and operational performance.
The challenge: unprecedented demand and elective backlog
At WWL, and as I imagine is the case at many trusts around the country, the acuity of patients is a lot higher today than we have seen historically. We have found ourselves at a crossroads, navigating the need to provide high-quality care amidst ever-growing demands. We are seeing the number of occupied bed days going up as discharge takes longer. The current scenario, where patients too frequently are having to be cared for on a corridor and long A&E waits is unacceptable.
What’s more, the aftermath of the pandemic has led to a substantial elective backlog, adding pressure to an already strained system. The Operational Planning Guidance 2024-2025 announcement is imminent, and we very much expect the elective recovery targets to be more ambitious. While at WWL we have successfully eradicated all patients on our 104-week plus list and we are well on our way to eradicating the 78-week waiting list, we know we have more to do. Our improvements around patient flow will be critical in ensuring we meet any new targets.
To successfully eradicate elective care backlogs, there must be bed capacity within hospital wards. We are currently operating at 100% capacity, and at that level elective surgery is at risk of further delay and short-notice cancellation. This will have a detrimental effect on patients in terms of both health and patient experience. Our Digital Transformation Strategy is designed to tackle this, placing patient flow as a cornerstone.
Patient Flow as a Catalyst for Change
Improving patient flow is not just about reducing waiting times. It is about ensuring patient safety, enhancing their experience, and optimising operational efficiency. We have homed in on discharge, which is often a low priority within trusts, as a strategic move to address these interconnecting elements.
Historically, our trust command centre relied on manual processes, whiteboards, and paper notes to track patient flow through the hospital which was cumbersome and inefficient. There was a lot of walking to the wards to determine the discharge status of a patient and there was a lack of real-time oversight.
The implementation of Altera’s Patient Flow solution is set to transform this by providing a comprehensive electronic bed management system. This system will enable us to track every step in the patient flow process from admission through to discharge, ensuring that each task is completed efficiently. We have conducted a current state analysis along with future state analysis and expected benefits and this work, along with the solution once implemented will certainly drive efficiencies.
The benefits we anticipate from this digital transformation are manifold. By having a visual system in place, we aim to double the number of people discharged before noon within the first few weeks of implementation, reducing pressure on A&E and improving patient outcomes. Coordination with porters and transport services will be streamlined, leading to better staff efficiency and, ultimately, improved staff health and wellbeing.
Longer term, our goal is even more ambitious. Ultimately, we want to achieve 40% morning discharge by 10am, ensuring that more patients receive the care they need promptly.
This will significantly help our elective care planning, reducing occupancy rates, and minimising the risk of cancellations, and having a digitally powered strategy is integral to us achieving these goals.
Positive Impact on Staff Wellbeing: A Hidden Gem in Improved Patient Flow
While the primary goal of enhancing patient flow is to improve patient outcomes and streamline operational efficiency, a significant but often overlooked benefit lies in the positive impact on staff wellbeing. Burnout amongst staff is all too common across the NHS and if staff are operating in challenging environments, which we know we are when we have 100% occupancy, then they are put under pressure. Staff wellbeing is really important to us here at WWL and we have lots of supporting programmes in place, but we recognise that no-one can work flat-out indefinitely. This is a risk, and one we work hard to mitigate.
Digitising our patient flow processes will remove the day-to-day frustrations related to inefficient manual processes, such as incidences where a patient’s discharge medications are not being processed, or transport is not booked on time. The patient flow solution will help us to foster more collaborative working practices and spend more time caring for patients. It will also allow teams to work more collaboratively, effectively and efficiently for example the system can be configured to alert our domestic services when a bed becomes vacated so they can begin the cleaning process in a timelier manner.
Looking Ahead: A Comprehensive Digital Strategy
Our journey towards digital transformation doesn’t end with patient flow. We have also invested in our Electronic Patient Record (EPR) infrastructure which, combined with the patient flow solution, is proving pivotal in providing real-time data for decision-making. This supports operational elements, such as the OPEL framework, but also aids in business case development and performance reporting.
The comprehensive data obtained through these systems empowers us to understand where improvements are needed, facilitating targeted interventions and enhancing patient care. It acts as a mechanism for validation, assurance to the board, and a valuable tool for collaboration with external partners.
We are now actively exploring how digital can support virtual hubs, community services, and collaborations with care homes. Our vision is to create a seamless, integrated healthcare system that prioritises patient needs, enhances staff efficiency, and keeps pace with the demands of the modern healthcare landscape.
As the first organisation to implement Altera’s Patient Flow solution, we are keen to share our learnings. At WWL we have processes in place to assist with patient flow, but we are implementing Altera’s digital solution to assist us to make greater efficiencies with our patient flow, bed management and discharge processes. We invite other trusts considering embarking on a similar initiative to come and to visit us at WWL to witness the positive impact it can have on driving improvements in patient care, staff wellbeing, and overall operational efficiency.
By Mary Fleming, Interim Chief Executive of Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust