Oxford University Hospitals NHS Foundation Trust

Activity in A&E exceeded capacity leading to breaches of national standards.

The CLEAR project identified the following issues:

  • Out of hours activity frequently exceeded resources.
  • Slow assessment and streaming leading to long waiting times.
  • Unnecessary patient moves for people who required admission and prolonged lengths of stay.

New ways of working including:

  • Optimised streaming of ambulatory patients.
  • Ringfenced workforce and clinical areas for initial assessment.

New models of care:

  • Extended hours for urgent care.
  • New process for ambulatory arrivals and bespoke area for assessment.

New models of workforce:

  • Nursing shift patterns matched to activity.
  • New navigator role to optimise patient flow.
  • Senior decision-maker in ambulatory patient areas.
  • Improved efficiency and reduced waiting times to assessment.
  • Improved patient safety and experience as a result of fewer moves and staff handovers.
  • Eradication of corridor care.
  • Reduced admission rates.
  • Shorter waiting times for around 48,000 patients.

“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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