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.”