The NHS is facing a severe crisis in its accident and emergency (A&E) departments, with record numbers of patients waiting for more than four hours to be seen. The situation has been worsened by the ongoing Covid-19 pandemic, which has put immense pressure on the health system. However, one Scottish health board may have found a way to improve the performance of its A&E services, by implementing a new model of care that focuses on patient flow and teamwork.
The problem of A&E waiting times
According to the latest figures from Public Health Scotland, only 81.8% of patients who attended A&E in Scotland in November 2023 were seen and either admitted, transferred or discharged within four hours. This is well below the national target of 95%, and the lowest figure since records began in 2007. The situation is even worse in some health boards, such as NHS Greater Glasgow and Clyde, where only 69.9% of patients met the four-hour target.
The long waiting times in A&E have serious consequences for patient safety, quality of care and staff morale. Patients who wait longer than four hours are more likely to suffer from complications, infections and adverse events. They are also more likely to experience dissatisfaction, anxiety and frustration with their care. Staff who work in overcrowded and understaffed A&E departments are more likely to suffer from stress, burnout and turnover.
The solution of NHS Lanarkshire
One health board that has managed to buck the trend of declining A&E performance is NHS Lanarkshire, which covers a population of about 655,000 people in central Scotland. In November 2023, NHS Lanarkshire achieved a 91.4% compliance rate with the four-hour target, the highest among all the 14 territorial health boards in Scotland. This is a remarkable improvement from the previous year, when NHS Lanarkshire had a 76.5% compliance rate.
How did NHS Lanarkshire achieve this turnaround? According to the health board, the key factor was the introduction of a new model of care in its three A&E departments, namely Hairmyres Hospital, Monklands Hospital and Wishaw General Hospital. The new model, which was piloted in Hairmyres Hospital in 2022 and rolled out to the other two hospitals in 2023, is based on the principles of patient flow and teamwork.
Patient flow is the process of ensuring that patients move smoothly and efficiently through the different stages of their care, from arrival to discharge. To improve patient flow, NHS Lanarkshire implemented several changes, such as:
- Creating a dedicated assessment and streaming area, where patients are triaged and directed to the most appropriate care pathway, such as minor injuries, majors, resuscitation or ambulatory care.
- Establishing a clinical decision unit, where patients who need further investigations or observation can be monitored and treated without occupying an A&E bed.
- Introducing a discharge lounge, where patients who are ready to leave the hospital can wait for their medication, transport or social care arrangements, freeing up beds for incoming patients.
- Enhancing the role of advanced nurse practitioners, who can assess, diagnose and treat patients independently, reducing the workload of doctors and improving patient satisfaction.
- Developing a multidisciplinary team approach, where doctors, nurses, allied health professionals, pharmacists, social workers and others work together to coordinate and deliver patient care, ensuring that patients receive the right care at the right time by the right person.
The impact of the new model of care
The new model of care has had a positive impact on both patients and staff in NHS Lanarkshire’s A&E departments. According to the health board, the benefits include:
- Reduced waiting times and crowding, leading to improved patient safety and quality of care.
- Increased patient satisfaction and feedback, indicating that patients feel more informed, involved and respected in their care.
- Improved staff morale and wellbeing, resulting from better working conditions, communication and collaboration.
- Enhanced efficiency and productivity, as staff can use their skills and resources more effectively and avoid unnecessary delays and duplication.
- Lower costs and waste, as fewer patients need to be admitted, transferred or re-attended, and fewer resources are consumed.
NHS Lanarkshire’s new model of care has been recognised as an example of good practice by the Scottish government, which has begun the formal process of sharing and spreading the learning and experience from the health board to other parts of the country. The health board has also received praise from patients, staff and external organisations, such as the Royal College of Emergency Medicine and the Scottish Health Council.
NHS Lanarkshire’s success in tackling the A&E crisis shows that it is possible to improve the performance of the NHS by adopting a patient-centred, team-based and evidence-informed approach to care. The health board’s experience may hold the key to fixing the NHS’ A&E crisis, not only in Scotland, but across the UK and beyond.
