East and North Hertfordshire NHS Trust

Performance in emergency care was declining.

The CLEAR project identified the following issues:

  • High volume of younger patients with urgent care needs in the emergency care majors stream.
  • Long lengths of stay for older patients in emergency care with a high conversion to admissions.

New ways of working including:

  • Enhanced triage pathways.
  • New validated technologies to stream patients at the front door.

New models of care:

  • Rapid assessment and triage for patients arriving by ambulance.
  • Urgent treatment centre within the emergency department.
  • Older people’s assessment unit co-managed between emergency and older people’s care.

New models of workforce:

  • Multi-disciplinary front-door triage team led by a senior.
  • Use of discharging radiographers in urgent treatment centre.

• Business case for implementing new models of care and workforce across the system.
• Care closer to home for a better patient experience and avoidance of emergency care.
• Greater collaboration across the system and between staff of all disciplines working across organisational boundaries.
• Potential savings identified as £1.8 million per annum.


“Training is provided through e-learning; didactic teaching from experienced NHS clinicians, managers and data analysts; and close supervision from experienced mentors. In this way the fellows are able to…understand NHS and local trust processes…[and] analyse patient flow and workforce data to put forward innovative ideas and suggest new ways of working. The CLEAR programme also delivers the essential generic skills required by the GMC’s professional capabilities framework to provide safe, effective, high quality care…allowing the Fellows to develop into effective, motivated leaders in their fields in the future.”

Dr Michelle Hayes – Chelsea and Westminster Hospital NHS Foundation Trust, CLEAR Fellow

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