Current Position

‘Changing The Conversation’ is the working title for a range of work underway to engage stakeholders in understanding ‘what good looks like’ for Emergency Departments (EDs) in Wales.

On behalf of ED’s, NHS Wales and the Welsh Government, the programme aims to realise benefits for patients, staff and the broader public in going far beyond the current debates regarding 4 and 12 hour waits. Our aim is to change the conversation to one which better describes the quality of care delivered by emergency departments that are meaningful to both staff and patients. We want to shine the light on opportunities to improve emergency care for the Welsh population, for example:

• We want to learn and share what ‘good’ triage and handover looks like, and we want to support ED’s to implement, innovate and improve
• We want to learn and share what ‘good’ clinical care looks like, and we want to support ED’s to implement, innovate and improve
• We want to understand, learn and share what ‘good’ flow out of the ED looks like and we want to support improved flow so that patients receive better-quality care
• We want to understand what ‘good’ looks like for patients and staff and we want to support value based care

Pathway Improvement Projects (PIPs)

We have established a PIP Working Group to support the implementation of ‘good’ handover and triage. This working group is well represented by frontline staff, with attendance from staff from both ED’s and the Welsh Ambulance Services Trust (WAST). An initial set of expectations to improve the process of handover and triage has been agreed by clinicians and an implementation plan is currently underway.

Versions of a potential “Once for Wales” handover and triage workflow, created by the working group have been amalgamated into a single version by the programme team. This links to evidence and research from various professional standards, which has then been further critically assessed by staff based on their clinical experience.

National Enablers for Service Improvement (NESIs)

We have worked with NHS Benchmarking to create structured comparisons between each ED in Wales to help define and implement best practice.

We have worked with Picker UK to produce a detailed staff experience survey for staff to provide their valuable feedback, which continues to shape the design of ED’s.

We have worked with Happy or Not to gather patient experience across Wales, which will inform the future provision of services within ED’s.

We have worked with Digital Health and Care Wales (DHCW) to develop a first cut of measures. These measures represent a mixture of reportable process measures and indicators on capacity, pressure and communications, which will be refined and added to over time. It should be noted that the measures:

• do not seek to replace the 4 and 12 hour performance indicators but instead complement them by providing greater context about the delivery of care in ED’s;
• are framed through a patient centred 5-step model for Emergency Departments, which is similar to the innovative and successful NHS Wales approach for Emergency Ambulance Services;
• will be useful for patient, public and media consumption, such as for the:
  • • acuity of patients presenting at ED’s, and the timeliness of care provided to them;
    • pressure reported by a Department correlated with activity;
    • time from arrival to triage for all patients;
    • time from triage to examination;
    • time from examination to referral;
    • time from referral to admission;
    • destination of patients when they leave the Emergency Department;
    • time from registration to discharge from Department by top 10 conditions and triage category;
    • also support assurance / performance management discussions between Welsh Government and LHBs on:
      • staff capacity to support timely triage;
      • planning of capacity to meet demand for assessment;
      • the role of inpatient specialties in supporting Emergency Departments; and
      • the efficiency of an Emergency Department.