The emergency department (ED) at Musgrove Park Hospital in Taunton has been successful in implementing the nationally-recognised ED Checklist, with support and a grant from the SW AHSN and South West Patient Safety Collaborative (SW PSC).
The ED Checklist helps to standardise and improve the delivery of basic care in emergency departments, systemising the observations, tests and treatments that need to be completed in a certain order. It serves as an aide-memoire for busy staff, and any doctor, nurse, bank or agency staff can join the department and provide the right care by following the time-based framework of tasks.
Musgrove’s ED Team initially concentrated on improving care for patients coming through the serious areas of the department. They identified areas for improvement around standardisation and wanted to improve these processes to ensure safe and reliable care for their patients.
The use of quality improvement (QI) methodology played an important part in the success of the deployment of the ED Checklist. Team members used iterative tests of change called ‘Plan, Do, Study, Act’ (PDSA) cycles to adapt, test, re-adapt and re-test the Checklist before going on to implement it. They also used Life QI, an online system created to assist people with QI projects. Using this type of approach allowed the ED Team to become engaged in the process and have ownership of the Checklist.
As a result of the ED Checklist being implemented, there have been a number of improvements made to patient safety in the department:
- a 30% improvement in escalation using the National Early Warning Score (NEWS) – a scoring system allocated to physiological measurements when patients are admitted to, or are being monitored, in hospital.
- a 16% improvement in recording initial NEWS observations (within 15 minutes).
- a 20% improvement of subsequent observations being performed as per NEWS protocol.
There have also been noticeable improvements in the department’s documentation, including:
- a 90% improvement in documenting refreshments provided.
- a 78% improvement in documenting pain levels.
Helen Gilliland and Laura Tennet, the project leads, said: ‘We are really pleased with the improvements the ED Safety Checklist has made so far in both the safety and care of our patients in ED. We will continue to monitor the effects of the Checklist and remain committed to improving the patients’ experience during their time in hospital. We would like to take this opportunity to thank the SW AHSN for all of the support given to our team during the project.’
The daughter of Brian Taylor 93, a patient at Musgrove Park, said: ‘My father was admitted to the Emergency Department at Musgrove Park Hospital in a very poorly state following a heart attack. The staff were great and really friendly, and I was very impressed by the use of the Checklist.’
The ED Checklist was originally developed and tested by University Hospitals Bristol NHS Foundation Trust with support from The Health Foundation and the West of England AHSN through its Patient Safety Collaborative.
The ED Team have actively engaged in the improvement process at all stages and are now working on a similar checklist for patients in other areas of the hospital.
For more information about the ED Checklist, please click here.