Going Live! The One Patient Pathway is up and running…

It was with great excitement and a slight feeling of trepidation that the ED Triage Team met on Monday morning. Ably led by C/N Joan Kane and ENP Sue Bagley, key players in its inception, the One Patient Pathway went live.

The pathway and how it came about are detailed in an earlier blog post. The process enables all patients to be met by a senior decision maker early in their patient journey. The aim is to improve ED efficiency and user (patients and staff!) experience.

Shifts as a member of the Triage Team are hard. The space is small, the patients are many (peaked at 39/hr on Monday afternoon) and the time is tight (our aim is to have front load assessment i.e. observations/blood tests/XR requests/ECG/analgesia) completed within 20 minutes. A multi-disciplinary approach is essential and traditional roles have to be shed, we are a team.

There are gains for everyone with the system. The gains for the patients are that they are given an idea of their likely ‘journey’ through the ED early on, tests are initiated early and results are available to guide further testing or referral when they get their more formal assessment. For the staff there is a new energy in the department. The triage shifts are tough but the pay back is in the shifts in other areas of the department which are notably calmer, more organised and (slightly) quieter!

As the process becomes embedded the early recognition of patients who will require hospital admission or specialty input can be used by the service to plan these events and help them to happen earlier in the patient journey.

To maximise the gains from the One Patient Pathway we are monitoring its success with a daily performance update displayed on a dashboard in the teaching room. As we learn more about the statistics and what they mean ‘in real life’ we can start making the little improvements that will have us running as smoothly as an F1 team. The initial statistics from this week are fantastic, the majority of patients are triaged within 30mins of arrival and a startling 47% of those requiring investigations have their first investigation within 30mins of arrival in the department. On our busiest day 98% of ED ambulatory discharges had their treatment completed within the 4 hour ED standard. A great team effort!

A big thanks to the whole ED team for their enthusiasm, energy and feedback. This is the start of a new way of working. It is tough but the benefits are huge. EDvolution!