Case Study - Homerton University Hospital NHS Foundation Trust

Emergency and elective care project

Homerton University Hospital NHS Foundation Trust separated emergency from elective care by creating highly trained, multiprofessional teams to care for emergency medical, surgical and orthopaedic admissions on two redesignated acute care wards.

The increase in dedicated beds was balanced by a corresponding reduction in general beds in other departments, as the improved immediate care on admission reduced the demand for them.

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EWTD compliance has been achieved by separating the rotas of junior doctors to allow time dedicated exclusively to the care of emergency admissions and time devoted to the development of skills in base specialties. This split varies according to the training needs of doctors and their specialties. The project was led by medical director Dr John Coakley, a consultant in intensive care medicine, together with chief operating officer Tracey Fletcher.

This kind of project needs good management, someone who can say the organisation will make changes and keep to a deadline.
Dr John Coakley, medical director

Dr Coakley said: "This kind of project needs good management, someone who can say the organisation will make changes and keep to a deadline."

The pilot had the support of the chief executive and executive directors who ensured members of their respective teams were actively involved with it throughout its duration.

Dr Coakley emphasises that it was important to acknowledge at the outset that not every aspect of their plans would run smoothly, he said: "We wanted to set up a system where any problems would be identified very quickly and more importantly, put right."

Within a short time, Homerton made changes to its original plans to have one 56 bed acute ward, created from two smaller existing wards, for emergency admissions. Dr Coakley said: "It soon became clear that this was too big, so we have changed to one 34 bed ward and 22 acute beds in another. Similarly, it became clear that the new junior doctors’ rotas were unnecessarily complicated.

"We expanded the consultants’ working day, they are now in the hospital for 12 hours to maintain the percentage of time junior staff are supervised. We maintained the junior staff training time while reducing their hours, but it’s too early to say whether the quality of training is better, worse or just different."

Chief operating officer Tracey Fletcher says one of the difficult aspects of the pilot was the timing, which coincided with the introduction of Modernising Medical Careers (MMC), she said: “If we were going to cut or lose hours and change the management of non elective patients, we had to look at how that may affect the elective side.

"It’s only after implementation that you can continue to rebuild further down the line."

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