1. Our journey and experience to date
Emergency care and streaming at Sherwood Forest Hospital NHS Foundation Trust
Our journey and experience to date

2. Our journey
Co-located A&E and Primary Care walk in service at Kings Mill Hospital
Two entrances and two receptions – patient chose which service to attend
Estates work – Single front door and reception
Patient chose service to attend at reception
Streaming protocols developed
Joint led streaming – 20% of all activity streamed to Primary Care
A&E led streaming – 23% of all activity streamed to Primary Care (30% of walk ins)

3. ED performance
From the 5th worst to one of the top 4 hour performers in the country (against a backdrop of a 15% rise in attendances)
From a CQC safety rating for A&E of ‘inadequate’ to ‘good’ and came out of special measures
Admission conversion rate to a bed now 16-20%
Reduction in time to triage < 15 minutes
A&E performance April 2017 = 95.92%, May = 95.55%, June = 96.68%, July = 95.53%

4. Performance

5. Strengths Co-located primary care service A&E led streaming model
Early senior input
Ambulatory Emergency Care Unit (AECU)
Admission not the safer option
Only admit those who cannot be treated at home/in the community
Do not admit for investigations
Jointly developed streaming protocols
Community input into A&E
Pathways to primary care and community developed

6. Weaknesses
Not compliant with the recommended Luton &Dunstable model as per NHSE guidance
Commissioners had envisaged Primary led streaming model but unable to staff
Change in Out Of Hours provider led to instability for period of time
Challenges in aligning governance processes across two different organisations
Victim of own success – build it and they will come!

7. Opportunities
Further pathways to primary and community care to be added to the streaming protocols
Expansion of AECU and associated activity
Paediatric pathways yet to be explored
Integrated discharge pathways via call for care (front door and back door)
Mirror model at local Newark Urgent Treatment Centre

8. Threats
NHSE mandating Luton and Dunstable model of streaming at the front door
Continued development of community services and the Integrated Urgent Care agenda will reduce the pool of patients that can be streamed – balancing metrics required

9. Contacts
For further information following this event please