How our hospitals have prepared for winter

Winter is always a challenging time at our hospitals. As we head into the festive season, urgent and emergency care departments are set to be under significant pressure once more, with knock-on effects across our services. Hospital director for Charing Cross, Hammersmith and Queen Charlotte’s & Chelsea hospitals Merlyn Marsden explains how our hospitals have prepared for winter.

Staff across our hospitals are working hard to build on progress made over the past two years to ensure that we can manage demand and continue to provide the best possible care for patients – in the right place, and at the right time. Many of our 11,000 staff will be working hard over the Christmas and New Year period to make sure that remains the case.

As well as creating 50 extra beds across our sites this winter, we’re focused on working collaboratively across our care pathways and in partnership with patients and their families to minimise waits for investigations, treatments and discharge arrangements.

The challenge we face

We’re busier than ever. Last winter, our main emergency departments and urgent care centres at St Mary’s, Charing Cross and Hammersmith hospitals saw nearly 110,000 adult patients – that’s more than 600 patients per day, on average, or around 25 every hour. On New Year’s Day 2018, we saw more than 800 adult patients.

Attendances at accident and emergency departments have been increasing particularly quickly. The number of adult attendances at our two main A&E departments at St Mary’s and Charing Cross increased by more than 4,000 between winter 2015/16 and winter 2017/18.

Our two ambulatory emergency care units (AEC), opened in 2016 as an alternative to A&E, saw a further 5,700 patients last winter. Prior to the opening of this service, these patients may have otherwise attended a mainstream emergency department. Patients seen in our AEC units are generally assessed and treated on the day or in follow-up, outpatient appointments.

Meanwhile, admissions into hospital via A&E have also increased over the same period, with more than 700 more adult patients admitted into St Mary’s and Charing Cross via A&E last winter compared to two years earlier. That’s meant finding, on average, four extra beds every single day of the winter.

Our A&E departments are therefore not only caring for more patients, they are also caring for patients who are more unwell – both those who are more likely to arrive as an emergency, and more likely to require inpatient treatment.

Improving our urgent and emergency care pathways

Over the past two years, the Trust has embarked on a dedicated programme of work to ease the pressure on our urgent and emergency services, especially during the winter. This has included both efforts to increase physical capacity, and, crucially, efforts to improve the flow of patients through our hospitals. We’ve seen significant improvements in patient care as a result, even in the face of growing demand, which we will continue to build on this winter. We are also working hard to ensure that our staff are looked after in what is a challenging season across all services.

Expanding our capacity

The Trust has secured an extra £5 million in funding to enable us to create an extra 50 beds this winter, which we are allocating across our sites, including in both emergency and inpatient units.

Following an expansion of the A&E at St Mary’s last year – which saw the creation of two new resuscitation bays and a new four-bed children’s assessment unit – Charing Cross Hospital’s emergency department is being refurbished and expanded this year. Three new ‘majors’ cubicles will be completed in January, with further expansion across the department due to follow.

Improving inpatient care and discharge processes

Over the past two years, through implementing national best practice on patient flow and discharge, and through improving our bed management system, we estimate to have created efficiencies equivalent to an additional 35 beds.

This winter, as well as continuing to implement a more effective bed management system, we are focusing on working with patients and their families so they can better understand their pathway through our hospitals. Our aim is to further reduce delays to patients being discharged.

With improved patient information, we will ensure that patients and their families know exactly what to expect about their care each day of their stay in hospital. This includes being as clear as we can be about discharge – when a patient can expect to be discharged, and what the clinical requirements are before they can go home or to community-based care. Our staff know that patients do not want to be in our hospitals any longer than they absolutely need to be.

How we’re performing

As these Trust-wide initiatives take effect, our performance against the national four-hour standard for A&E waiting time has been steadily getting better over recent months – from 82.4 per cent of patients admitted, discharged or transferred within four hours in February 2018, to 90.6 per cent in October 2018. We are also doing significantly better than this time last year – our performance was 86.6 per cent in October 2017.

While we anticipate that the coldest months of the winter will once again be challenging, we are confident that efforts by staff across the Trust to work with patients and build on our recent progress will help ensure we continue to deliver the best possible care.

Every working day, we publish a capacity update on our website – click here to see today's capacity update

We've also created a set of checklists and factsheets to help our patients, GPs and staff access the services they need as quickly as possible this winter. See our 'quick links' at left to download these documents.