Triumph for best practice as A&E trolley waits are slashed by NPAT

NPAT worked with hospitals that had the worst trolley-wait figures in the country, in a bid to tackle the high numbers of patients caught up in 'care logjams'.

According to Karen Castille, NPAT's director of emergency service programmes, the results were impressive and its work will now be shared across the NHS in a document due to be published within the next fortnight.

'We did have a number of A&E departments where patients had been waiting over 24 hours.

Certainly at the end of the work no-one was in that situation. We also cut drastically the numbers who were waiting over 12 hours, which had also been a problem.

The vast majority of trusts had no-one in that situation by the end, ' she told HSJ.

'It is true that other A&E departments not involved also saw trolley waits fall but not as significantly as those involved in the initiative, ' she added.

A project manager was employed at each trust, with advice coming from NPAT on redesigning care pathways and ensuring that the skills of all staff working within A&E were exploited to the full. A 'baseline' on waiting times was established to ensure that there were genuine improvements.

Mrs Castille said the credit for the improvements should go to the trusts themselves. 'We were simply facilitators - that was all. We provided advice and support, but it was the staff working at the A&E departments who were responsible. It is those people who understand best the specific nature of the pressures on A&E departments at their own local level.'

The document, Improving the Flow of Emergency Admissions, will be sent to all health authorities, hospital trusts, primary care trusts and primary care groups.

Workshops are also being run by NPAT on the issue.

'It is about sharing good practice and ensuring that the system revolves around the needs of the patient rather than the other way round - a patient-centred service, ' said Mrs Castille.

And she added: 'We see the work as only the first step. One of the most important things is to ensure that what we all learnt with the project is available across the whole of the NHS. It is about ensuring best practice.'

Among the 16 hospitals taking part were Barnet and Chase Farm Hospitals trust, the Royal Liverpool and Broadgreen University Hospitals trust and Central Manchester/Manchester Children's University Hospitals trust.

Pat Lathey, project manager at Bromley Hospitals trust, told HSJ:

'It was very useful.NPAT funded a project manager for six to eight months, and it was nice to have someone concentrate on whole system for that length of time.

'It allowed us to find out how the system operated at the beginning.

Sometimes you think you know how it works, but you find it far more complicated.'

Ms Lathey said meetings were held with the other trusts to pool knowledge and experience.

'One of the most important things was that it wasn't a topdown process with models being imposed from above. We could tailor solutions according to local variations. That is one of the reasons this scheme will benefit other trusts.'