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Nurse leads hospital out of A&E breach

Getting all hospital staff – from porters to managers – involved was the key to improving accident and emergency performance at a trust which had been failing the target for years, according to the nurse who led the work.

Gloucestershire Hospitals Foundation Trust director of nursing Maggie Arnold was put in charge of turning around performance against the four hour A&E target in May after the foundation trust regulator Monitor stepped in and ordered the trust to improve.

The trust had been in significant breach of its authorisation as an FT since September 2009 for persistently missing the target that 95% of patients be admitted to a bed or treated and discharged within four hours of arrival. When a foundation trust is in significant breach the board and executive team are subject to increased external pressure and face being dismissed if improvements are not made.

Performance improved from 90.5% in the last three months of 2011-12 to 96.1% in the first three months of 2012-13. On Friday Monitor announced the trust had made the necessary improvements and was no longer in significant breach.

Ms Arnold said although quality of care had never suffered the board acknowledged patient experience was affected by the long waits.

On taking on the role, she began by speaking to staff in all parts of the trust’s two hospitals.

Ms Arnold said: “Communication with all staff, from porters to the general managers to the information people, was crucial so that everybody understood what it was we were trying to achieve and that they had a part to play. It is not just down to the A&E staff.”

The trust took a number of actions to improve patient flow including recruiting more emergency nurse practitioners and radiographers with emergency nurse practitioner training to deal with patients with minor injuries.

They have also introduced earlier and more frequent ward rounds to speed up patient discharge with some specialties carrying out two ward rounds a day. New consultation cubicles were built in emergency departments at both Gloucestershire Royal and Cheltenham General hospitals.

Ms Arnold added: “The staff have been so good and flexible in achieving this. It has been a real team effort.”

Readers' comments (12)

  • Amazing what spending a bit of money can do!

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  • Well done, anyway...

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  • tinkerbell

    well done maggie, a bit of common sense approach can often work wonders. Unfortunately common sense isn't so common and appears to be in very short supply across the land right now.

    What we need is people like yourself out there walking the walk and a lot less talk.

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  • Well Done Maggie!
    Now then, minister for health... what abouth a Nurse Lead NHS for a change, eh?

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  • Its December 2012 the problem has existed since 2009

    Did it really take 3 years to "talk to people"

    I would not be proud of such an appalling demonstration of management failure!

    By the way has the problem of ambulances queuing outside Cheltenham hospital A&E been resolved?

    Thought not!

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  • Anonymous | 24-Dec-2012 9:23 am

    Thanks for bringing a touch of reality to the proceedings. The lack of real detail amongst all the crowing about 'targets' was bothering me.
    A relative of mine was papped out of an A&E within two hours last week....only as far as the AMU, where he didn't see a doctor until six hours after his arrival at the hospital. No diagnosis and no treatment during that time. Hospitals are just sausage factories. Simply moving the sausages from one place to another before the sand hits the bottom of the hour glass means absolutely nothing.

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  • Anonymous

    'Rudolph/tinkerbell | 23-Dec-2012 5:23 pm

    well done maggie, a bit of common sense approach can often work wonders. Unfortunately common sense isn't so common and appears to be in very short supply across the land right now.'

    Unfortunately common sense isn't so common - TICK !!!


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  • tinkerbell

    Anonymous | 28-Dec-2012 0:47 am

    I totally agree with your sausage analogy.

    In a bid to meet targets, save money, make a profit, evidence everything, people have been dehumanized into a product/commodity who are being moved around on some kind of 'monopoly' board.
    The patients have become a pawn in a game and we are all losing the 'plot' in an effort to achieve a target rather than providing compassionate care.



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  • tinkerbell | 30-Dec-2012 6:02 pm

    my hospital was also turned into a factory where patients were processed on a conveyor belt system. I am not sure what type it was or whether its purpose was the manufacture of sausages as this was, for obvious reasons, kept top secret from those working on the front line. We were just grateful when patients were returned to our wards after any of the investigations they were assigned to succumb to, for fear of leaving any stones unturned in the diagnostic jigsaw, still intact and uncomplainng!

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  • tinkerbell

    just to clarify i wasn't suggesting that any patients were made into sausages in the processs.

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  • what they are turned into seems less worrying than the process our patients are put through when they enter a medical establishment. the conveyor system of modern health care seems more suited to the manufacture of goods that it does to providing humane human healthcare.

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  • michael stone

    I've just briefly glanced over a couple of these, reading one word in ten, and I'm appalled that patients are being made into sausages !

    I shall be contacting the Mail about this new NHS scandal !!!

    And the EU because it clearly breaches 193(g) of the EU food regs 2007 !

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