Improving Capacity Management and Patient Flow at Medway NHS Foundation Trust

Truly effective change within the NHS requires a commitment from leadership to innovate, learn quickly, measure success, and lead by example. It requires a willingness to overhaul existing processes and a commitment to the right technology partner who will work side by side with our teams understand the goals and realise the benefits. In a recent “lunch and learn” with Proud2bOps, I sat down with TeleTracking’s Solutions & Strategy Director, Carl Davies, to outline the transformation in performance achieved within six weeks of introducing our Care Co-ordination Centre and explained how the £1.2 million operational savings have been invested to deliver quantifiable improvements in patient care.

Sustaining Fundamental Change

Medway NHS Foundation Trust (Medway) is a single-site, acute trust that, until very recently, has been entirely non-elective due to the overwhelming demand on ED, with over 600 attendances every day. In common with the majority of NHS organisations, Medway’s lack of operational visibility into patient flow led to endemic delays – in processing, notification, preparation and transport.

Transforming this situation required very significant operational change and a way to ensure every part of the organisation involved in patient flow, from clinicians to facilities management, administration to transport, was able to work together effectively.

Creating a Centralised Co-ordination Centre

Setting up the Care Co-ordination Centre has transformed operational visibility. Underpinned by TeleTracking’s electronic bed and capacity management system, the CCC is organised like an airport “traffic control” centre, it is a dedicated resource accessed and overseen by a combination of clinical and operational individuals with a clear role to play in moving a patient into, though, and out of the system.

Run by senior clinical site managers, the centre also includes bed placement specialists and a facilities supervisor who oversee dedicated bed cleaning teams and porters. The Care Co-ordination Centre ensures all the people with a role in managing patients across their care journey are connected through a single source of information and highly effective and automated workflows. A representative from Medway’s transport provider also ensures requests can be rejigged in response to bed demands. Plus, Medway has an emergency planning team who can leverage end-to-end hospital oversight should an incident occur.

Quantifiable Improvements in Efficiency and Care

Six weeks after the go live in October 2023, we undertook an initial performance review which revealed significant improvements across every Key Performance Indicator (KPI):

Bed status: 60% advanced visibility of planned discharges – a figure that continues to improve week on week.
Bed availability: The time from the moment a patient leaves a bed until it is available for the next patient (idle bed time) has improved to an average 68 minutes, a figure that includes the deep UV cleans. Previously this process took 150 minutes (2 ½ hours) and cleaning was at that time undertaken by nurses.
Patient wait: 50% reduction in patient wait time (from ED to a released bed) from 4 hours to 2 hours.
Time to care: 50 hours of additional nursing time has been released back into delivering care every single day though the use of a dedicated bed cleaning team.
Porter efficiency: the automated, dispatcherless porting system intelligently allocates tasks based on porter location and priority activity. The average time taken for each job, from request to finish, is 29 minutes.

Continual Improvement

These operational improvements have measurable financial implications. At the six-week review, we calculated a £1.2 million return on investment based on existing performance gains – far outstripping the expenditure. This is just the start. Medway is committed to continual patient flow improvement, under the Patient First management strategy, and is actively exploring the data provided through TeleTracking’s system to drive effective change.

One noted improvement is the change in time of discharge, with 13% of discharges now occurring before 10am. Overall the discharge time is 2 ½ hours earlier every day, with the average confirmed discharge time of 2:50 pm, providing a massive benefit to patients waiting in ED for a bed.
In addition, with around 100 patients every day requiring ED admission, Medway has released 200 additional hours daily when patients are not requiring ED space while waiting for a bed, with clear implications for reducing ED pressure.
Patient length of stay has been reduced by three to four hours per patient. With over 75,000 admissions every year, this equates to a very significant reduction in demand for bed time.
Medical outliers have been reduced.

Transforming Patient Care

Achieving these improvements, including significant financial savings, has never been about reducing staff or closing wards. The goal is to improve processes, increase time back to care, and transform patient experience. Prior to the creation of the Care Co-ordination Centre, Medway was an entirely emergency care driven organisation, elective care was stopped, and the day surgery unit was overwhelmed by non-elective patients.

In contrast, this winter Medway has not stopped any elective procedures at all due to capacity. We have delivered 109% of the ERF target. Our day case unit has been functioning as it should, with day case rates increasing. We are now in the top 10 in theatre productivity times. We have leveraged operational improvements and financial gains to deliver better care for patients.

Valuing Partnership

A key message for any NHS organisation is that big projects don’t have to take years, but it does require an investment in training and encouraging your teams. It took Medway just 22 weeks from contract signing with TeleTracking to going live, including the fundamental change to operating procedures. The relationship has been key to ensuring not only the technology works but also that people are engaged and processes designed for purpose. Partnership is critical for what we do in operations – we can’t do it all ourselves, we need partners with expertise, not providers that give you a product and leave you to get on with it.

Medway has a true partnership with TeleTracking. We work closely together, speaking every week, gaining insight from TeleTracking about how we are using the system to release time and become more operationally optimised, but also about our partnership and plan to meet our long-term goals and strategic work around Integrated Care Systems delivery.

Carl Davies at TeleTracking, confirms, “Partnership is a big part of our philosophy. For over a decade, we’ve worked with the NHS and recognise that while our system can have a significant and transformative impact on patients and staff, it is a complex task to change internal structures and processes. We are committed to all our partnerships, with a team built around clinicians and operational leads within the NHS providing experience and an understanding about the impact on the ground.”

Watch the full recording of the webinar below.