NHS Quicker: Informing attendance choices for urgent careThu 5th Sep 2019
Emergency Department (ED) waiting times have increased substantially over recent years. In the UK this is measured using the four-hour waiting time standard, which states that 95% of patients should be assessed, treated, then either admitted or discharged within four hours of presentation at an ED or a Minor Injury Unit (MIU). Within EDs the NHS has not met this standard nationally since 2013/14.
In 2015 the Torbay & South Devon Urgent Care Network consisted of one ED (Torbay Hospital) and seven MIUs; all MIUs met the standard, while Torbay Hospital’s adherence was just under 75%. It was found that those living nearest to the ED were more likely to attend this facility with low-acuity conditions, rather than travel to a more appropriate MIU with potentially much shorter wait times.
To address the problem, researchers at the University of Exeter Business School alongside stakeholders from Torbay proposed the use of near real-time data and digital technologies to shape demand for urgent care. This idea was developed further through the Health and Care IMPACT Network, and expanded across the South-West of England. The Network was founded through a collaboration between Torbay & South Devon NHS Trust and the University of Exeter, with the aim of improving the delivery of health and care through applied research.
A meeting of the network was organised to codesign the functionality of the solution and brought together many stakeholders, including NHS staff and patient representatives. This led to the realisation of the NHSquicker platform which provides live wait time data. This data is streamed through multiple patient flow management systems that are in use in the ED departments and MIUs operated by Trusts in the region. The platform comprises of a business intelligence dashboard, a backend system and a mobile app (NHSquicker). The app is also integrated with the NHS Directory of Services, which allows easy identification of alternative local health services such as pharmacies.
NHSquicker uses ‘nudge’ to improve patients’ decisionmaking related to ED/MIU attendance choice. It lists urgent care facilities that are in close proximity to the user and presents them in ascending order based on the combined value of wait time with travel times. This helps patients make more informed decisions such as whether to visit a facility which may be nearer to them but with a long waiting time or travel to an alternative location that is further away but with a shorter waiting time. The nudge approach aims to reduce pressure on EDs by redistributing demand for the treatment of minor ailments to the network of MIUs.
A cross-sectional survey of low-acuity NHS patients who were waiting for care found that 68% believed that NHSquicker would be useful in the future. Analysis of visits to MIU/ED facilities in the Torbay & South Devon region during peak hours shows a redistribution of demand, with a reduction in ED attendances and an increase in MIU attendances. Further work is needed to ascertain the degree to which NHSquicker has contributed to this shift. The work which started from one Trust has now expanded, with six Trusts sending real-time data from six EDs and 17 MIUs, whilst the NHSquicker app has seen increased uptake in SouthWest England.
Sources of research funding: NHSquicker has received £60,000 of funding, which includes contributions from the Economic and Social Research Council’s Impact Acceleration Account, the South-West Academic Health Sciences Network and the Torbay & South Devon NHS Trust.