Brighton A&E bosses say waiting times are better

Waiting times for Brighton and Hove’s accident and emergency (A&E) patients are much better and will improve further, according to hospital bosses.

A report by Brighton and Sussex University Hospitals NHS Trust spells out changes that have been made to tackle problems in A&E at the Royal Sussex County Hospital.

The trust’s chief executive Matthew Kershaw is expected to present the report to councillors at Hove Town Hall next Tuesday (10 September).

Mr Kershaw has been invited to discuss progress at the Brighton and Hove City Council Health and Wellbeing Overview and Scrutiny Committee.

The trust’s report says: “Overall we have seen a sustained improvement in waiting times in the Emergency Department (ED) since April and zero breaches of the 12-hour standard (no patient to wait more than 12 hours from decision to admit to admission).

“Performance against the four-hour standard was achieved in May, June and July but has been more difficult to maintain in August and overall performance was at 93.3 per cent for the month.

“Our focus is now to address this in September and onwards for the coming winter.

Matthew Kershaw

“A large part of our programme of work was around changing doctors’ rotas and referral practices and this required new consultant appointments and new ways of working.

“While these appointments have now been made we will not see the full benefit until October this year.

“We have also identified that we have more to do in surgery and around the time of day and number of discharges particularly at the weekends.

“(The Royal Sussex) remains with consistently high ED attendances and a significant daily variation in the number of patients passing through the Emergency Department.

“Within this there is a significant daily variation in ambulance conveyances (from 69 to 128 each day in July and August) and the associated admissions.

“This is important because between 40 and 45 per cent of the patients who come to us by ambulance will need admission to hospital.

“The more we can understand this variation the better we can influence it through the work that the (Brighton and Hove Clinical Commissioning Group) CCG and partners are doing so admission to hospital becomes the exception.

“We also remain with a significant number of patients who make their own way to the ED who do not need to be seen in hospital.”

The report says that the key changes have included the introduction of a Patient Assessment Team in A&E to ensure

• early identification of the sickest patients
• early instigation of treatment including pain relief
• early and appropriate ordering of investigations

The report also says that A&E bosses were working with the CCG, the South East Coast Ambulance Service (SECAMB) and other partners to reduce the daily variation in attendances.

It says: “It may be that we will need to reintroduce GP cover into the ED if attempts to reduce the number of ED attendances for patients who could be seen in primary care do not bring any real benefit.

“Having recruited to additional consultant posts, we will be changing the medical cover rotas in October so we ensure early senior clinical review and maximise the number of patients who can be safely managed without admission or admitted and discharged within two to three days.

“In the meantime the clinical teams are working closely with the Hospital Rapid Discharge Team in order to maximise the number of patients who can be managed without admission

“Care of the elderly wards at the Royal Sussex all now have daily ‘board rounds’ along with planning meetings to ensure all arrangements are in place for patients who are scheduled for discharge the next day.

Xavier Nalletamby

“They also complete a weekly review of all patients who have been in hospital for more than 14 days to ensure that everything is being done to ensure their safe and timely discharge.

“This is working very well and we have seen an overall decrease in the number of patients.

“Our digestive diseases ward (58 beds) has daily multidisciplinary meetings to ensure medication required on discharge is ordered well ahead and to escalate other issues as required.

“The vascular team is also running daily ‘board rounds’ and again planning ahead for safe discharge of patients including those who need onward care at a neighbouring hospital.

“Electronic whiteboards on all our wards are proving invaluable, enabling us to see at a glance where each patient is on their pathway and identify and deal with potential delays.

“We have also seen a significant rise in patients attending with mental health issues and work is under way with the Sussex Partnership NHS Foundation Trust in order to enable us to enhance our current response so that we do not have patients waiting many hours for assessment and treatment within the ED.”

The trust said that it had “indicated at the outset that this would not be a quick fix”.

It added: “We will see further benefit from our work in September and October, but without a reduction in ED attendances it will be very difficult to sustain required performance.

“Clinicians are engaged in the Urgent Care Clinical Forum led by the CCG chair Dr Xavier Nalletamby and the chief of clinical leadership Dr Naz Khan.

“Discussions are under way with SECAMB as to how they can help reduce the variation in the number of patients who are brought to the ED each day.

“There is also work under way across the local health economy in relation to anticipatory care, reducing ambulance conveyances to the ED and prevention of admission in a crisis which should start to deliver a reduction in the overall volume of attendances through the ED.

“There is still a lot of work for (the trust) to do but this is in hand.

“Our Implementation Board met weekly for the first eight weeks but now meets fortnightly to give more time to implement the required changes and we continue to meet regularly with the CCG and partner organisations also.”

The meeting is open to the public and is due to start at 4pm next Tuesday (10 September) at Hove Town Hall.