Back issue listing | Subject Index | Journal listing by subject | ImpAct Back issue listing

An A-Z of winter pressures

Managing emergency admissions at Birmingham Heartlands and Solihull Trust (Teaching).

ImpAct bottom lines

Why was the initiative launched?

Like all hospitals, Birmingham Heartlands and Solihull is faced each year with the need to plan and respond to a growth in emergency admissions during the Winter. For the Winter 1997/98, the hospital was determined to learn from its experience in previous years and put in place robust and effective plans to manage future Winter pressures.

What was done?

The work was directed by a ‘Winter Pressures Group' chaired by the Trust's Medical Director - Dr Craig Skinner - and involving all the senior staff of the hospital responsible for the management of emergency medical beds in the Trust. They collated and analysed information about emergency activity in previous Winters. This provided the group with a detailed picture of how the Trust had managed the increased demand in its past. A ‘bed model' was then developed, providing a basis to plan for the future. The group found ways to bring together independently formulated policies, such as: trolley wait protocols, ward round protocols and discharge policies.

An important product from the work of the group has been the creation of ‘The A-Z of Winter Pressures'. This is a detailed reference guide to all initiatives used to meet increased demands of Winter. The A-Z sets out the roles and responsibilities of key individuals within the Trust and the resources available to them. In addition, the A-Z provides a summary of all the plans and initiatives developed by health authority, the local authority and the Trust. The main areas covered in the A-Z are shown in the Table.

An A-Z of Winter pressures
A&E Contingency Plans Recruitment
Admission Deflects Retention - Nursing
Alerts - Green - Yellow - Red Discharge Lounges Situation Reports
Annual leave Equipment Social services
Bed Bureau Media calls Specialist nurses
Bed Management Medical Cover - Winter Wards Step-down beds
Bed Meetings Monitoring staff levels Surgery
Bonus Schemes Nurse Advisers on call Trigger points
CART Operations director Ward opening . . .and closing
Community Services Performance Management Ward round protocols
Consultant of the day Professions Allied to Medicine  

The A-Z also includes detailed contingency arrangements indicating when the emerging situation demands action. ‘Trigger points' - linked to plans for bed management meetings - are defined. These - Stage I: Green, Stage 2: Yellow, and Stage 3: Red - indicate the urgency of response required and provide guidance about who will do what and what action should be taken.

Does it work?

The system has now been in place for two Winters and the benefits of the approach are already being felt. The level of emergency admissions in Winter 1997/98 were low, particularly in January, and did not place undue pressures on the system. A detailed review of its performance showed the system to work well. This review included discussion groups to enable staff in the hospital to ‘have their say' about whether the new system worked. A number of useful comments came out of these discussions, such as support for a ‘one-stop' contact for facilities services.

Two examples of specific improvements arising from the work and achieved during 1997/98 are:

  1. Additional multi-disciplinary staffing was able to reduce discharge delays - down 27% from the previous Winter.
  2. Introduction of a locum GP within A&E was effective in reducing waiting times for patients to be seen and preventing inappropriate admissions.

During 1998 the Trust added to its ‘Winter pressure' initiative. For example ‘step down' beds have been identified in Nursing Homes and Residential Homes providing rapid access for GPs and Nursing Teams to prevent admission and for the Trust to facilitate early discharge. Other initiatives, such as the creation of a Home Care Team, were possible because of Winter Pressures funds. As well as developing specialist services the focus was placed on the needs of the elderly.

A detailed analysis of activity in Winter 1998/99 is being undertaken. Early indications are that the hospital coped with the increased demand created by the ‘flu epidemic in January 1999. Use of the systems has limited any impact on surgical elective work at the hospital. Moreover, the Trust was able to complete an ambitious waiting list initiative a month earlier than planned.

Tips for success

To find out more contact

Mark Houghton
Admissions and Discharge Manager
Birmingham Heartland and Solihull NHS Trust
Green East
Birmingham B9 5SS
Telephone 0121 766 6611, extension 5108
Fax 0121 773 6726
Copies of ‘The A-Z of Winter Pressures' are available.

previous or next story in this issue