Edinburgh Emergency Medicine is currently undergoing a massive change looking at the process by which we receive, assess and manage patients attending our department.
Over the next 3 blog posts we will explain the following:
Why are we trying this change? And what is #PODSquad?
How have we gone about planning for #PODSquad
Has it worked?
The Emergency Department at the Royal Infirmary of Edinburgh sees between 350 and 430 adult patients per day. Over the past 18 months we have been challenged by rising attendances, rising times to triage, rising times to first assessment and a worsening 4 hour performance. Furthermore, patient complaints have increased and staff morale has dropped, resulting in increasing departures and leading to a general feeling of unhappiness across the department. This is unlikely to be an unfamiliar situation to anyone working in an Emergency Department anywhere in the UK at present.
A few years ago, faced with similar circumstances, we undertook a major Kaizen project to improve our department and created a system called One Patient Pathway. This system relied on a rapid, senior-led front-loaded assessment system where all patients were seen in a triage area and decision made on initial investigations and treatments. This led to patients being seen quicker and investigations and treatments being started earlier. It worked well. But as patient numbers grew the system began to struggle. When over 30 patients per hour arrive, the team were struggling to deliver bespoke care and the consultant struggled to review every patient to make clear decisions (one patient every 2 minutes). We made interventions such as creating parallel streams of work and creating guides and support to identify the patients in most need of care and what they needed but without replicating our early successes.
Elsewhere in the department we tried other interventions to improve patient and staff experience, such as creating a bespoke Minor Injuries Unit and an Ambulatory care/Observation Unit. Both of these have been successes in their own right but without an overall impact on the main department.
It was time to try something new.
The idea we had was not new. It had been used with success in the USA but we were unaware of it being used in the UK before. The idea was to split the department into a series of separate areas known as Pods, hence #PODSquad.
Each Pod would be staffed by a number of doctors, nurses, nurse practitioners and clinical support workers with a senior doctor such as a consultant assigned to each Pod. Patients would enter the department and after a rapid triage would be sent to one of the Pods. Each Pod would receive a mix of patients with varying triage categories. Patients would be received into the Pod by the team and would get an early assessment and decisions about investigations with initial treatments started. The patient would remain under the care of this Pod until a decision was made regarding destination.
The primary aim of the system is to reduce time to first care-provider by ensuring that a patients first significant point of contact is with their care provider, but we also are aiming to reduce time to senior review, time to analgesia and investigation and ultimately, time to discharge (either home or into the larger hospital system), whilst improving the experience for both patients and staff working in the department.
In the next post we will go into some more detail about how the Pod system works and how we prepared for the test and have undertaken this in the department.