Ensuring that patients receive prompt treatment in our Emergency Departments (ED) remains a priority for our Trust, as well as reducing delays so patients can go home from our wards as soon as they are medically well enough.  

Jo Player is a clinical operational site manager in our Bed and Site team. Having spent more than a decade working in ED, she explains the government-set waiting time standards for patients and the impact on patient care if these are not met.

Having moved to a role which involves working with wards to monitor available beds, Jo discusses how she quickly learnt more about the challenges wards face in ensuring their patients don’t experience any delays in leaving hospital.

“I started my nursing career with our Trust in 2008, at the ripe old age of 39. I had completed a short student placement in Queen’s Hospital ED and did several bank shifts there as a healthcare assistant whilst training. Although I had loved and learnt so much from all my ward placements, I knew exactly where I wanted to work.

ED is for most patients their first experience of our Trust and their first impression could be a lasting one. The patient turn over can be rapid and so staff there don’t get to know their patients very well. However, there will always be those that stay with you in your thoughts.

The challenges faced there are quite different to those faced elsewhere within our Trust. When first qualified, my main concern was to learn my trade and care for my patients but, as I got promoted to a senior sister, the challenges I faced became different.

In ED there are several government-set standards that have to be met. The first standard is the ambulance offload time. If a patient is not offloaded within an hour this is called a ‘black breach’ and has to be escalated. Staff in the department constantly have to make the decision to offload a patient from an ambulance or use the available cubicle for a patient that may have already been sitting on a chair for some time, but who also requires a bed. This can be quite a difficult position for the staff to be in.

Of course, these delays also impact our ambulance colleagues. My partner Rob has worked for the London Ambulance Service for 25 years. While waiting at our hospitals he can hear broadcasts on their radios about people waiting for ambulances; so, it can be frustrating for them too.

Next, is the four-hour access standard; patients should not be in the ED for longer than four hours. Once a decision to admit a patient has been made, a bed should be available for them within 12 hours. Fortunately, patients rarely wait for more than 12 hours for a bed.

Standards are set for a reason. Studies have shown that a patient stay of two hours in ED compared to that of 12 hours or more has an increase in mortality rate of around 2 per cent. Each day, our Trust has to report our performances to the Commissioning Support Unit, who, in turn, relay the information to NHS England and NHS Improvement. Standards give an overall indication of quality of care. However, at all times, we need to be mindful that our patients are individuals and that their care should be given as such. In real terms, as care givers, failing these targets means a patient is on an ambulance trolley in a corridor, or is in a cubicle, in a busy, noisy ED for many hours when they should be on a ward.

After 12 years in ED I realised that I lacked knowledge of what was happening in the rest of our Trust. I had become used to my ED ‘bubble’. I had learnt so much there and worked with such an amazing team of people, but it was time to broaden my horizons. So I took a secondment with the Bed and Site team as a clinical operational site manager.

It didn’t take me long to realise that our wards were experiencing their own challenges!

Many of the patients have quite complex needs, many are cohorted for their own safety and discharging them to a safe environment is very time consuming. Many will require equipment, increased or new packages of care and sometimes a placement within the community to a care or nursing home or rehabilitation centre. More recently, the discharge process has further become delayed with the need for a negative Covid swab before returning to their nursing or care home.

Working with the ward areas, in my new role, has given me an insight into how hard our colleagues on the wards work to overcome their own challenges, especially over the last few months! They are also fantastic patient advocates, putting patient care and experience at the forefront of their decisions.

On any day at Queen’s Hospital alone, we admit up to 80 plus patients. Therefore, we need to discharge that many patients, who are medically well enough to leave hospital, to ensure that patient experience and flow is the best it can be.

What I have found on the wards is that everyone assists with the discharge of our patients, both clinical and non-clinical staff. We achieve the best for our patients when we all work as one team, towards the same goal which is to give excellent care and to ensure a timely and safe discharge for all of our patients. With the Covid-19 pandemic upon us, it is imperative that we do all we can to get ourselves in the best position possible for the approaching winter.”