West of England A&E initiative recommended for national roll-out

Hospital trusts across the country are being urged to use an initiative developed in the West of England to improve patient safety in emergency departments.

The recommendation to all trusts in England to implement the ‘Emergency Department (ED) Safety Checklist’ comes in a letter issued this week by NHS Improvement.

Designed to address the shared challenge of ensuring patient safety during periods of crowding, the ED Safety Checklist was originally developed and tested by University Hospitals Bristol NHS Foundation Trust with support from the West of England Patient Safety Collaborative and the Health Foundation.

The 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.

Following the success of the initiative at University Hospitals Bristol, the West of England Patient Safety Collaborative supported all seven emergency departments in the region (spanning six hospital trusts and the ambulance service) to adopt the Checklist, developing a special toolkit to aid its adoption.

Unless they are already using an equivalent evidence-based system, hospitals trusts are now being encouraged to use both the ED Safety Checklist and the supporting toolkit.

In 2017 the Health Service Journal named the ED Safety Checklist ‘best patient safety initiative in A&E’ and it won second prize in the Royal College of Emergency Medicine’s annual award.

Use of the Checklist (or an equivalent) is now supported and endorsed by NHS Improvement, NHS England, the Royal College of Emergency Medicine, the Royal College of Nursing and the Care Quality Commission.

NIHR CLAHRC West is evaluating the use of the checklist in the hospital trusts and ambulance service in the West of England and will produce advice and recommendations based on the research to facilitate the wider implementation of the checklist.

Dr Jon Banks, Research Fellow at CLAHRC West, said:

“We’re still working on our evaluation and will share the full report later in 2017. But we have identified some early lessons for the implementation and use of the checklist. These are based on our research with a range of staff at two emergency departments that have implemented the checklist. We would be very happy to discuss these with NHS trusts that are planning to use the checklist.”

If you want to discuss implementation with us, please get in touch at clahrcwest@nihr.ac.uk.

Deborah Evans, Managing Director of the West of England AHSN, said:

“It is fantastic news that our local ED Safety Checklist is now being recognised and picked up at a national level, particularly as it was created by clinicians for clinicians.

 

“I believe this is the role of the 15 Patient Safety Collaboratives, which are coordinated by the Academic Health Science Networks across the country. We seek out evidence of best practice in healthcare settings and help to test this more widely, so that improvements and innovations can be most effectively rolled out nationally and mainstreamed where appropriate.”

Emma Redfern is Consultant in Emergency Medicine at University Hospitals Bristol, where the ED Safety Checklist was first piloted. She added:

“The checklist is embedded into routine practice in our emergency department and we are delighted with the results so far. This national recognition proves that a simple, well-designed checklist such as this can greatly improve the delivery of safe care.”

Beccie Watkins is Associate Director of Nursing and was previously Clinical Lead for A&E at Weston Area Health NHS Trust when the Checklist was tested.

Beccie said:

“As one of the pilot sites for the ED Safety Checklist we consistently used the tool both in the department and at clinical meetings. We found it a helpful checklist that can be used to quickly identify hot spots or safety concerns. Using the checklist we can escalate any issues of concern to a consultant and senior clinical colleagues.

“It also offers assistance in triangulating data retrospectively so that trends can be identified to improve patient care. I’m sure this will be of use to other A&Es across the country.”

Director of Safety at Gloucestershire Hospitals NHS Foundation Trust, Andrew Seaton commented:

“We are delighted to have been involved – the checklist has been a great tool to help us improve both safety and patient experience in the ED. Led by our clinical staff, a multidisciplinary team has been involved in making this checklist work at its best in both our emergency departments.”

For more information about the Emergency Department Safety Checklist and the supporting toolkit, please visit www.weahsn.net/ed-checklist/.