Patient service experience

Imperial College Healthcare NHS Trust is committed to providing world-class care to all our patients. Service experience is one of the new emergency department indicators, which highlights the value and importance the Department of Health attaches to the patients’ experience of emergency care. This means we as providers of emergency care can reliably and consistently obtain your views of the service and act on suggestions as to how we can improve.  

Our patient experience plan will be multi-faceted recognising that any single patient experience system will not reach all patients. Some groups of patients may be unable to respond because of their condition at the time of presentation (unconscious, seriously ill or unable to speak). Others may be disadvantaged because of language, and the use of electronic systems may also discourage some, particularly the elderly.

Our strategy will aim at including all types of patients. Therefore we will be exploring the use of email feedback as well as paper-based patient satisfaction questionnaires.

October will see the introduction of the electronic ‘I track’ devices in our emergency departments These will allow patients and carers to comment on our services in ‘real time’ and we should have the first set of results in November. Read more in the emergency department patient service experience page.

We also plan to use ‘discovery interviews’ to obtain some more qualitative responses about our patients’ experience. The discovery interviews, for which we will seek ethical approval, will explore the patients’ understanding of a quality service, reason for attending, the reception, assessment and care given, and the their sense of  overall satisfaction.

Patient group for whom we will have a particular focus  will be older patients, particularly those with some levels of cognitive impairment such as dementia.

The recent Health Service Ombudsman’s report highlighted major deficiencies in the care of older people in acute hospitals. An increasing number of older people are attending emergency departments and accessing acute care services, and there is a growing concern for the safety of frail older people managed in hospital. Older people are admitted to hospital more frequently, have longer length of stay and occupy more bed days in acute hospitals compared to other patient groups. 

Most patients are admitted to hospital via the emergency department which is a key interface in the health and social care system where older people with crises can be managed. The clinical assessment of frail older people is challenging because they often present with a number of problems such as falls, immobility or just feeling unwell. All of these factors can make the immediate diagnosis difficult. History taking may be challenging because of sensory impairment, dementia or delirium. A positive attitude and a willingness to adapt processes to manage frail older people is essential to improving their and their carers’ experience.

Initiatives and actions

  • Emergency staff in Charing Cross, Hammersmith and St Mary’s hospitals will have dementia training which will reflect the Trust’s Dementia Strategy.
  • An elderly care group, which includes acute geriatricians (doctors specialising in the care of the elderly) and nursing and medical staff from all three sites, have agreed an auditable proforma for assessment of older patients.
  • The assessment area for older patients should be located in a quieter, preferably separate, area of the department where observation is possible but noise, interruptions and overstimulation is minimised. However, it should not be close to an exit.  Clinical equipment in this area should be kept to an absolute minimum and, where possible, create an ambience consistent with the age of the patient (examples that are proven to work are pastel shades, flowery curtains, old-fashioned pictures, a clock with large numbers, a comfortable armchair).
  • The emergency department should be ‘dementia-friendly’, with signs in large font and added visual aids such as pictures.
  • All signage should be at eye level so the older patient does not have to crane their neck to read it as this can cause them to lose their balance.
  • Bins should all have silent lids. The ones that snap down and make a loud bang cause unnecessary distress to those who are confused and visually impaired.
  • We are considering the use of colour-coded wrist bracelets for “wanderers “ so they can be easily identified.

Homeless patients    
The health of people who are homeless is often the poorest in our communities. Homeless people are more likely to suffer from mental and physical ill health, and at the same time be unable to access the health services they need. Often these individuals have the highest need, the poorest health outcomes and can require the
most costly services if left untreated.  
A recent national audit of homeless people in 2010 showed that:

  • 8 out of 10 homeless patients have one or more physical health need
  • 7 out of 10 have one or more mental health need
  • In the past 6 months, 4 in 10 had been to A&E at least once and 3 in 10 had been admitted to hospital
  • Almost 1 in 3 regularly eat less than 2 meals per day

Improving the health and experience of emergency care is a challenge for most trusts as homeless people fall beneath the radar of routine planning.

Initiatives and actions
To address this, a ‘homeless peer mentor’ project has been designed and set up to improve the health of homeless people in our community. The project plan between Groundswell, NHS Westminster and Imperial College Healthcare NHS Trust aims to train peer mentors (previously homeless people) to support this hard-to-reach groups with their  complex health and social needs to access healthcare appropriately and in a timely way.  

This project, which is being funded by The Innovation Fund, offers an opportunity to form excellent partnership and links between agencies. We home that the model will be replicable and extendable to other marginalised and vulnerable groups. To date the peer mentors have supported 65 patients to over 300 health appointments.  

The project leads have also been successful in securing a second round of funding to support dissemination   to another borough  and to establish links with Charing Cross and Hammersmith emergency departments.