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The four-hour wait: How tech design can reshape life in A&E

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The “four-hour wait” is a still a significant target for us in the Emergency Department (ED) and, as everyone knows, has a considerable impact on patient care and the overall functioning of the healthcare system. This refers to the target set by NHS England, which aims to have patients spend no more than four hours from arrival in the ED to either admission, transfer or discharge.

The target is designed to improve patient experience and ensure that patients receive timely and appropriate care and treatment, essential to ensure patient safety. Reducing waiting times in A&E can lead to faster diagnosis, treatment and relief for patients in need of immediate medical attention, which in turn can potentially save lives.

A look at A&E wait times

A&E wait times remain high across the country with many people choosing to seek urgent care as they wait for elective care. The backlog is high, with more than 7.5m on the waiting list.

New “stretched” targets have been set, in light of the new capital funding from NHS England. This means that trusts “over-delivering” on two emergency care targets this winter will be awarded a share of a new £150m capital fund. The thresholds are:

 

  • to achieve an average of 80 percent against the four-hour A&E target in quarter four of 2023–24
  • to complete at least 90 percent of ambulance handovers within 30 minutes during quarters three and four
Are these targets achievable?

The 2023–24 planning guidance set trusts a 76 percent target for four-hour performance. Only five acute trusts recorded performance above 80 percent in the three months to June, the latest quarter. This includes our Sunrise™ EPR client Maidstone and Tunbridge Wells Trust, alongside Northumbria Healthcare, Harrogate and District, Dorset County Hospital and Blackpool Teaching Hospitals foundation trusts.

How can we achieve these targets?

In recent years, these user-focused design principles have gained momentum in various industries, including healthcare. By placing the needs and experiences of patients, as well as those who look after them, at the heart of the design process, we can reimagine how ED functions and make the wait a more comfortable, efficient and compassionate experience for patients, improving the overall quality of care.

As a senior doctor in an A&E department in a UK hospital trust, I know first-hand that implementing and using technology that works with the user not only improves staff well-being, efficiency and patient experience, but also streamlines our processes. Here’s how:

 

  • Electronic patient records (EPRs) – The role of a comprehensive, intuitive EPR (such as Sunrise, which I use clinically) cannot be overstated. These are in effect digital versions of the traditional paper chart centralised medical histories, diagnoses, medications, treatment plans, immunisation dates and test results among other data. As a senior doctor, I often need to make critical decisions swiftly. A well implemented EPR system, designed with users, can provide a quick snapshot of a patient’s medical history, enabling me to make critical decisions without delay. An efficient EPR can also facilitate seamless communication across different departments, reducing the chances of clinical errors and ensuring a smoother, safer patient journey through ED.
  • Patient tracking systems – A real-time patient-tracking solution, such as the tracking boards I use, offers a continuous update of not only the patient’s status, but also location in ED. This can be a game-changer in the high-stakes, fast-paced environment I work in, where seconds count. By eliminating the need to manually check a patient status or location, it can help you stay updated, effectively coordinated with the team and focused on what you need to be doing—delivering great care.
  • Mobile devices and apps – Mobile apps designed specifically for the needs of clinical staff can be instrumental in improving efficiency. By providing me with a well-designed mobile app that offers me all the key information in an intuitive and focused offering, it can integrate into my workflow seamlessly and securely, leading to quicker decision-making and ultimately leading to improved patient care and satisfaction.
  • Telemedicine – The advent of telemedicine has revolutionised the delivery of healthcare services. In an ED setting, it can prove incredibly useful for initial patient triage, providing remote consultations, and for patients requiring follow-up care. This can reduce the patient load in A&E, enabling clinicians like me to focus on those who need to be in A&E. We have seen this used successfully with some of our clients.
  • Interactive patient systems – Providing patients with accurate, easily understandable information about their conditions and treatments is key to reducing their anxiety and improving patient satisfaction. Interactive patient portals can be used to deliver this information effectively, especially when integrated as part of the EPR. These patient portals must provide accurate, relevant and easy-to-understand information.
  • Artificial intelligence (AI) and machine learning (ML) – As a senior doctor, I am required to identify patterns, make connections and make decisions quickly. AI and ML tools assist in diagnostic processes, analysing patterns in patient symptoms, vital and lab results more quickly and accurately than humans could alone. By providing critical insights, these tools augment clinical decision-making by clinicians such as myself, ensuring more accurate and timelier diagnoses.

In recent times, the NHS has faced additional pressures, such as those brought on by the COVID-19 pandemic, which has further strained healthcare services. Nevertheless, the four-hour wait remains an important benchmark to improving efficiency.

By adopting an iterative approach, implementing, testing, gathering feedback, refining and testing again, always striving for continuous improvement, paying attention to how these solutions are designed, we are prioritising the core values of patient-centric care and creating a compassionate and efficient ED experience that can make a significant impact on the clinical world, which also supports clinicians like me, and supports those who face moments of crisis.

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