Blog: Using quality improvement to improve performance in Emergency Department at Torbay

Dr Joanne Watson is Deputy Medical Director at Torbay and South Devon NHS Foundation Trust. Before taking up this post in January 2017, she spent some time at the Institute for Healthcare Improvement (IHI), where Patient Safety Officer training originated. Joanne talks about the impact of the quality improvement (QI) work that has been done at Torbay and South Devon NHS Foundation Trust.

“Going through this winter in the NHS is hard on all fronts,  if you are working in it, the pressure is constant, with stress and tensions running high. If you are feeling unwell and listen to the almost daily news around the struggling NHS, confidence is lowered and extra worries creep in. The beginning of February is traditionally one of our busiest times.
In February 2016, the Care Quality Commission (CQC) put an inadequate rating on our Emergency Department (ED). We were in top escalation at that time, and they witnessed our extreme difficulties first hand, warts and all. It is amazing that two years on in February 2018, the department is performing so well now. The CQC came back in May 2017 and rated the ED as “Good” and Quality Improvement has been key to this turnaround.
In 2016, a multi-disciplinary team from Torbay and South Devon NHS Foundation Trust ED attended the Patient Safety Officer training funded by South West Patient Safety Collaborative (you may have read Sandra Boosey’s blog about the development of Safety Huddles at the Emergency Department in Torbay).

Their story is told through the amazing run-chart (above). With applied Plan Do Study Act (PDSA) cycles and QI methodology they turned around performance. In winter 2016, we were one of the top performers in NHS England against this national target. Working in ED continues to strengthen despite how tough it has been in the 2017/18 Winter. Even in OPEL 4 (Operational Pressures Escalation Levels), the department is able to respond and keep people safe with no return to those darker days of February 2016.
Through continuing QI work led by Sandra Boosey and Jane Dewar (both QI coaches and experts in this methodology) performance has been maintained. Rapid assessment at the front door has been established as the norm through this work and goes forward with initiatives such as orthopaedic consultants early review, team development etc.
What we have achieved is really incredible, and all due to a good approach with QI skills – this will be around in the Trust for years to come.”
If you would like to find out more about the work of the South West Patient Safety Collaborative, please contact patientsafety@swahsn.com

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