Creating a culture of quality in the ED - making...
1
Scan me! www.nhsaaa.net to visit our website: Find us on Facebook at www.facebook.com/nhsaaa Follow us on Twitter @NHSaaa Creating a culture of quality in the ED - making quality improvement everyone’s business Background The Scottish Government 20/20 vision (2011) set out its strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland. Within NHS Ayrshire and Arran, a new Emergency Department (ED)/Combined Assessment Unit (CAU) opened transforming the delivery of unscheduled care and enabling the appropriate patients to be seen in the appropriate department, thus improving delivery of emergency care. Within the ED this transitional period was a suitable time to develop and introduce a framework for ongoing continuous clinical improvement. Aims We aimed to establish and maintain a continuous quality improvement (QI) programme. Identified priorities for improvement were: • Improved staff confidences /competencies to assess deteriorating patients • Improved care of deteriorating/septic patients • Improved imaging process for out-of-hours patients Methodology Using improvement methodology we devised a driver diagram defining our improvement plan. PDSA (plan, do, study, act) methodology was used to carry out small tests of change and identify further areas for improvement. Improving journey and imaging process for out of hours patients Our aim here was to facilitate and expedite the care and management of minor injury patients attending ED during out of hours period. It was our vision to increase patient satisfaction by reducing their overall waiting time with the department. Initially the focus has been on supporting staff through a competency based framework to allow them to request x-rays out of hours. Additionally staff have been collecting baseline data to identify which aspects of the process could/should be improved. A focus of the month poster was developed to raise staff awareness of the improvement project and introduce a framework for ongoing continuous clinical improvement. Improved Staff confidence/ competencies to assess deteriorating patients We collected baseline data which has identified the need for improvement: Results/Outcomes Improved Care of Septic Patients The LNA identified areas in which nursing staff felt they would need additionally training/ competencies to be able to successfully initiate a nurse led sepsis 6 bundle . Unsurprisingly these were aspects of the bundle that are normally carried out by medics in the ED. Conclusion This is still very much ‘work in progress’ within the ED. Staff attitudes have changed with many embracing quality Improvement as part of our ‘daily business’. We plan to continue to support and develop a framework for Improvement which will be inclusive for all staff. By doing so we will be able to deliver the high quality healthcare that the people of Ayrshire and Arran expect and deserve. It is our vision that the introduction of both our new structured documentation and our new ‘buddy’ system will increase the compliance with patients having a documented A-E assessment and improve staff confidence and competency in assessment of the deteriorating patient. Improved Care of Septic Patients Our aim here was to introduce a nurse led sepsis 6 bundle. Again we indentified staffs learning needs by carrying out a learning needs analysis (LNA). Following this we devised a competency framework and process to allow nurses to carry out all aspects of the sepsis 6 bundle within the ED MIS18-058-DM Sharon Deans SCN, Sadie Wilson SCN, Rosemary Murray SCN, Stephanie Frearson S-04 Aim / Outcome Primary Drivers Secondary Drivers Improved staff confidence/competencies to assess Deteriorating patients • Development of ED specific resus documentation • Re-visit ED Care Rounding • Improved Family Communication To establish/maintain an ongoing continuous Quality Improvement programme within UHA Emergency Department and achieve 95% compliance by July 2018 • Identification of suitable staff • Implementation of training/competencies • Development of imaging criteria Improving patient journey and Imaging process for out of hours patients • Team development to effectively deliver care required in relation to deteriorating patients • Reliable identification and treatment of deteriorating patients • Reliable identification and treatment of septic patients Improved Care of Septic Patients Develop/test A-E approach document Electronic Communication Board Revised Care rounding documentation Family Info leaflet Test ‘Sepsis Nurse’ Role Introduction of NEWs Focus of the Month Algorithm for process Competency framework Change Ideas for Testing University Hospital Ayr Emergency Department Improvement Plan 2017-2018 Evaluation of the ABCDE Approach Ratings Scales:[ 1= not at all 2= a little confidence, limited knowledge and skills in this area 3= reasonably confident/ I feel there are some gaps in my knowledge 4= confident 5= extremely confident QUESTION 1 2 3 4 5 Airway Airway obstruction Paradoxical chest and abdominal movements (‘see-saw’ respirations) and the use of the accessory muscles of respiration. Central cyanosis Breath sounds at the mouth or nose Breathing General signs of respiratory distress: sweating, central cyanosis, use of theaccessory muscles of respiration, and abdominal breathing Count the respiratory rate. Assess the depth of each breath, rhythm and whether chest expansion is equal on both sides. Chest deformity Breath sounds e.g. Stridor or wheeze Circulation Look at the colour of the hands and digits: are they blue, pink, pale or mottled? Assess the limb temperature by feeling the patient’s hands: are they cool or warm? Measure the capillary refill Assess the state of the veins Count the patient’s pulse rate Palpate peripheral and central pulses, assessing for presence, rate, quality, regularity and equality. Measure the patient’s blood pressure. Disability Make a rapid initial assessment of the patient’s conscious level using the AVPU method Review and treat the ABCs: exclude or treat hypoxia and hypotension. Drug-induced causes of depressed consciousness. Examine the pupils (size, equality and reaction to light). Exposure Examine the patient properly, full exposure and minimise heat loss. FEBRUARY FOCUS OF THE MONTH SCIENCE IMPROVEMENT PROJECT 2017/2018 NURSE REQUESTED IMAGES FOR MINOR INJURIES(OOH PERIOD ) AIMS To facilitate and expedite the care and management of minor injury patients attending Accident and Emergency during out of hours period. To increase patient satisfaction by reducing their overall waiting time with the department To provide registered nurses opportunity to develop professional practice by achieving competence in examing a pre-determined group of patients attending Accident & Emergency (requesting x-ray examination as indicated) To ensure service delivery with Accident and Emergency remains patient focused. BOUNDARIES OF PRACTICE Fingers & thumb Foot Forearm Lower leg Big toe Wrist Ankle Hand Heel Foreign body exclusion TRAINING PROGRAMME INCLUDED *Professional Accountability within the framework of professional practice *Decision making at triage *Principles of clinical examination *Ionising radiation guidelines *Theory and implication of ionising radiation *X-Ray protocols *X-Ray requesting *Supervision *Assessment process and competency 0 10 20 30 40 50 60 70 80 90 100 2/1/18 2/2/18 2/3/18 2/7/18 2/10/18 2/12/18 2/13/18 2/15/18 2/18/18 2/23/18 2/24/18 2/25/18 % of patients Date UHA ED Total % of patients with a Physiological Deterioration who have a documentented A-E Nursing Assessment in Resus bay Median Overall how well do we identify and initiate treatment of deteriorating patient Well Well but could improve Could improve No answer Are you confident inserting a venflon? YES NO Unsure further training would be of benefit? Are you confident taking bloods? YES NO Unsure further training would be of benefit? Are you confident taking blood cultures? YES NO Unsure further training would be of benefit? As part of our ongoing Improvement work within ED we plan to review/improve our care of deteriorating and/or septic patients. To enable us to understand staff’s understanding and learning needs please complete the following questionnaire. This should then be returned to Sadie or Kimberley. Many thanks. Please answer yes or no to each question YES NO UNSURE COMMENTS 1. Are you confident with the triage process? If no do feel further training would be of benefit? 2. If a patient scores high on NEWs are you confident with the escalation process? If no do you require further training? 3. Have you completed a PGD for administration of fluids? 4. Are you confident inserting a venflon? If no do you require further training? 5. Are you confident taking bloods? If no do you require further training? 6. Are you confident taking blood cultures? If no do you require further training? 7. Are you confident taking ABG’s? If no do you require further training? 8. Are you confident with the administration of IV AB’s? If no do you require further training? Overall how well do we identify and initiate treatment of deteriorating patients? Please circle appropriate answer A I think we do it very well B I think we do it well but could improve C I think we could improve Improved Staff confidence/ competencies to assess deteriorating patients Our aim here was to develop new structured documentation within the resus bay to support nursing staff to carry out an A-E assessment of deteriorating patient’s. This is currently being tested in the ED. Additionally we carried out a confidence score to identify staff learning needs. Improving journey and imaging process for out of hours patients University Hospital Ayr Emergency Department Triage NEWS SCORE Is it 4 or more? Refer to Nurse led Sepsis 6 Identifiers YES NO Does the pt have a score of 2 or more accompanied by +ve or presumed infection? YES NO Triage pt as orange – contact nurse in charge or nurse co-ordinator Immediately begin sepsis 6 bundle STOP AND THINK! Continue normal triage process University Hospital Ayr Emergency Department Nurse Led Early Identification and Delivery of Sepsis Six Bundle • If score is 2 or more and accompanied by positive or presumed infection then this patient has SEPSIS - triage as orange – inform the nurse co-ordinator. • Implementation of Sepsis Six Bundle must be completed within one hour. • Vital signs require to be measured every 15 minutes throughout this episode. • Reassessment is required at 1 hour of initiation- are there signs of organ dysfunction, BP systolic < 90 after fluid challenge, urine output <0.5mls/kg, O2 needed to keep sats >90%? Is NEWs > 4? Could this be due to Infection and/or does patient look sick? Yes but source unclear at present Pneumonia UTI Abdo pain or distension Cellulitis/septic arthritis/infected wound Device-related Infection Meningitis Recent Chemo/immuno compromised Other (specify).................................... Identification Criteria Met Time...................... YES because at least 2 of the below: Systollic <90 Temp >38.3 Temp <36 Heart rate >90/min Resp rate >20/min Acutely altered mental state Blood Glucose > 6.6 in absence of diabetes NO as less than 2 of the above 0 10 20 30 40 50 60 3/7/17 10/7/17 17/7/17 24/7/17 31/7/17 7/8/17 14/8/17 21/8/17 Time in Minutes Date UHA ED Triage To X-Ray Time (Baseline) Median 0 10 20 30 40 50 60 70 80 12/1/17 12/8/17 12/15/17 12/22/17 12/29/17 1/5/18 1/12/18 1/19/18 1/26/18 2/2/18 2/9/18 2/16/18 2/23/18 Time in minutes Date UHA ED Triage to Xray Time Median Early signs of improvement have been noted since the introduction of staff competency framework/training. This is an on-going programme with many staff still to complete.
Transcript of Creating a culture of quality in the ED - making...
Scan me!
www.nhsaaa.net
to visit our website:
Find us on Facebook at www.facebook.com/nhsaaaFollow us on Twitter @NHSaaa
Creating a culture of quality in the ED - making quality improvement everyone’s business
BackgroundThe Scottish Government 20/20 vision (2011) set out its strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland. Within NHS Ayrshire and Arran, a new Emergency Department (ED)/Combined Assessment Unit (CAU) opened transforming the delivery of unscheduled care and enabling the appropriate patients to be seen in the appropriate department, thus improving delivery of emergency care. Within the ED this transitional period was a suitable time to develop and introduce a framework for ongoing continuous clinical improvement.
AimsWe aimed to establish and maintain a continuous quality improvement (QI) programme. Identified priorities for improvement were:
• Improved staff confidences /competencies to assess deteriorating patients• Improved care of deteriorating/septic patients• Improved imaging process for out-of-hours patients
MethodologyUsing improvement methodology we devised a driver diagram defining our improvement plan.
PDSA (plan, do, study, act) methodology was used to carry out small tests of change and identify further areas for improvement.
Improving journey and imaging process for out of hours patientsOur aim here was to facilitate and expedite the care and management of minor injury patients attending ED during out of hours period. It was our vision to increase patient satisfaction by reducing their overall waiting time with the department.
Initially the focus has been on supporting staff through a competency based framework to allow them to request x-rays out of hours. Additionally staff have been collecting baseline data to identify which aspects of the process could/should be improved.
A focus of the month poster was developed to raise staff awareness of the improvement project and introduce a framework for ongoing continuous clinical improvement.
Improved Staff confidence/competencies to assess deteriorating patientsWe collected baseline data which has identified the need for improvement:
Results/Outcomes
Improved Care of Septic PatientsThe LNA identified areas in which nursing staff felt they would need additionally training/ competencies to be able to successfully initiate a nurse led sepsis 6 bundle .
Unsurprisingly these were aspects of the bundle that are normally carried out by medics in the ED.
ConclusionThis is still very much ‘work in progress’ within the ED. Staff attitudes have changed with many embracing quality Improvement as part of our ‘daily business’. We plan to continue to support and develop a framework for Improvement which will be inclusive for all staff. By doing so we will be able to deliver the high quality healthcare that the people of Ayrshire and Arran expect and deserve.
It is our vision that the introduction of both our new structured documentation and our new ‘buddy’ system will increase the compliance with patients having a documented A-E assessment and improve staff confidence and competency in assessment of the deteriorating patient.
Improved Care of Septic PatientsOur aim here was to introduce a nurse led sepsis 6 bundle. Again we indentified staffs learning needs by carrying out a learning needs analysis (LNA).
Following this we devised a competency framework and process to allow nurses to carry out all aspects of the sepsis 6 bundle within the ED
MIS
18-0
58-D
M
Sharon Deans SCN, Sadie Wilson SCN, Rosemary Murray SCN, Stephanie FrearsonS-04
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
PDSA (plan, do, study, act) methodology was used to carry out small tests of change and identify further areas for improvement. Improved Staff confidence/competencies to assess deteriorating patients – our aim here was to develop new structured documentation within the resus bay to support nursing staff to carry out an A-E assessment of deteriorating patient’s. This is currently being tested in the ED. Additionally we carried out a confidence score to identify staff learning needs.
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
Sharon Deans, Sadie Wilson, Rosemary Murray - Senior Charge Nurses ED Stephanie Frearson Improvement Advisor Background The Scottish Government 20/20 vision (2011) set out its strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland. Within NHS Ayrshire and Arran, a new Emergency Department (ED)/Combined Assessment Unit (CAU) opened transforming the delivery of unscheduled care and enabling the appropriate patients to be seen in the appropriate department, thus improving delivery of emergency care. Within the ED this transitional period was a suitable time to develop and introduce a framework for ongoing continuous clinical improvement. Aim We aimed to establish and maintain a continuous quality improvement (QI) programme. Identified priorities for improvement were:
• Standardised A-E approach to nursing assessment; • Improved care of deteriorating/septic patients • Improved imaging process for out-of-hours patients
Methodology Using improvement methodology we devised a driver diagram defining our improvement plan
Aim / Outcome Primary Drivers
Secondary Drivers
Improved staff confidence/competencies to assess Deteriorating
patients
• Development of ED specific resus
documentation• Re-visit ED Care Rounding• Improved Family Communication
To establish/maintain
an ongoing continuous Quality
Improvement programme within UHA Emergency Department and
achieve 95% compliance by July
2018
• Identification of suitable staff• Implementation of
training/competencies• Development of imaging criteria
Improving patient journey and Imaging process for
out of hours patients
• Team development to effectively deliver care required in relation to deteriorating patients
• Reliable identification and treatment of deteriorating patients
• Reliable identification and treatment ofseptic patients
Improved Care of Septic Patients
Develop/test A-Eapproach document
Electronic Communication Board
Revised Care rounding documentation
Family Info leaflet
Test ‘Sepsis Nurse’ Role
Introduction of NEWs
Focus of the Month
Algorithm for process
Competency framework
Change Ideas for Testing
University Hospital Ayr Emergency Department
Improvement Plan 2017-2018
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
Evaluation of the ABCDE Approach
Ratings Scales:[
1= not at all
2= a little confidence, limited knowledge and skills in this area
3= reasonably confident/ I feel there are some gaps in my knowledge
4= confident
5= extremely confident
QUESTION 1 2 3 4 5 Airway Airway obstruction
Paradoxical chest and abdominal movements (‘see-saw’ respirations) and the use of the accessory muscles of
respiration.
Central cyanosis
Breath sounds at the mouth or nose
Breathing
General signs of respiratory distress: sweating, central cyanosis, use of theaccessory muscles of respiration, and abdominal breathing
Count the respiratory rate.
Assess the depth of each breath, rhythm and whether chest expansion is equal on both sides.
Chest deformity
Breath sounds e.g. Stridor or wheeze
Circulation
Look at the colour of the hands and digits: are they blue, pink, pale or mottled?
Assess the limb temperature by feeling the patient’s hands: are they cool or warm?
Measure the capillary refill
Assess the state of the veins
Count the patient’s pulse rate
Palpate peripheral and central pulses, assessing for presence, rate, quality, regularity and equality.
Measure the patient’s blood pressure.
Disability
Make a rapid initial assessment of the patient’s conscious level using the AVPU method
Review and treat the ABCs: exclude or treat hypoxia and hypotension.
Drug-induced causes of depressed consciousness.
Examine the pupils (size, equality and reaction to light).
Exposure Examine the patient properly, full exposure and minimise heat loss.
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
Improving journey and imaging process for out of hours patients – our aim here was to facilitate and expedite the care and management of minor injury patients attending ED during out of hours period. It was our vision to increase patient satisfaction by reducing their overall waiting time with the department. Initially the focus has been on supporting staff through a competency based framework to allow them to request x-rays out of hours. Additionally staff have been collecting baseline data to identify which aspects of the process could/should be improved. A focus of the month poster was developed to raise staff awareness of the improvement project
Results/Outcomes Improved Staff confidence/competencies to assess deteriorating patients We collected baseline data which has identified the need for improvement:
FEBRUARY FOCUS OF THE MONTH
SCIENCE IMPROVEMENT PROJECT 2017/2018 NURSE REQUESTED IMAGES FOR MINOR INJURIES(OOH PERIOD ) AIMS To facilitate and expedite the care and management of minor injury patients attending Accident and Emergency during out of hours period. To increase patient satisfaction by reducing their overall waiting time with the department To provide registered nurses opportunity to develop professional practice by achieving competence in examing a pre-determined group of patients attending Accident & Emergency (requesting x-ray examination as indicated) To ensure service delivery with Accident and Emergency remains patient focused. BOUNDARIES OF PRACTICE Fingers & thumb Foot Forearm Lower leg Big toe Wrist Ankle Hand Heel Foreign body exclusion TRAINING PROGRAMME INCLUDED *Professional Accountability within the framework of professional practice *Decision making at triage *Principles of clinical examination *Ionising radiation guidelines *Theory and implication of ionising radiation *X-Ray protocols *X-Ray requesting *Supervision *Assessment process and competency
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
It is our vision that the introduction of both our new structured documentation and our new ‘buddy’ system will increase the compliance with patients having a documented A-E assessment and improve staff confidence and competency in assessment of the deteriorating patient. Improved Care of Septic Patients The LNA identified areas in which nursing staff felt they would need additionally training/ competencies to be able to successfully initiate a nurse led sepsis 6 bundle
Overall how well do we identify and initiate treatment of deteriorating patient
Well
Well but could improve
Could improve
No answer
Are you confident inserting a venflon?
YES
NO
Unsure
further training would be of benefit?
Are you confident taking bloods?
YES
NO
Unsure
further training would be of benefit?
Are you confident taking blood cultures?
YES
NO
Unsure
further training would be of benefit?
Unsurprisingly these were aspects of the bundle that are normally carried out by medics in the ED.
0102030405060708090
100
2/1/
18
2/2/
18
2/3/
18
2/7/
18
2/10
/18
2/12
/18
2/13
/18
2/15
/18
2/18
/18
2/23
/18
2/24
/18
2/25
/18
% o
f pat
ient
s
Date
UHA EDTotal % of patients with a Physiological Deterioration who have a documentented
A-E Nursing Assessment in Resus bay
Median
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
It is our vision that the introduction of both our new structured documentation and our new ‘buddy’ system will increase the compliance with patients having a documented A-E assessment and improve staff confidence and competency in assessment of the deteriorating patient. Improved Care of Septic Patients The LNA identified areas in which nursing staff felt they would need additionally training/ competencies to be able to successfully initiate a nurse led sepsis 6 bundle
Overall how well do we identify and initiate treatment of deteriorating patient
Well
Well but could improve
Could improve
No answer
Are you confident inserting a venflon?
YES
NO
Unsure
further training would be of benefit?
Are you confident taking bloods?
YES
NO
Unsure
further training would be of benefit?
Are you confident taking blood cultures?
YES
NO
Unsure
further training would be of benefit?
Unsurprisingly these were aspects of the bundle that are normally carried out by medics in the ED.
0102030405060708090
100
2/1/
18
2/2/
18
2/3/
18
2/7/
18
2/10
/18
2/12
/18
2/13
/18
2/15
/18
2/18
/18
2/23
/18
2/24
/18
2/25
/18
% o
f pat
ient
s
Date
UHA EDTotal % of patients with a Physiological Deterioration who have a documentented
A-E Nursing Assessment in Resus bay
Median
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
Improved Care of Septic Patients – Our aim here was to introduce a nurse led sepsis 6 bundle. Again we identified staffs learning needs by carrying out a learning needs analysis (LNA).
Following this we devised a competency framework and process to allow nurses to carry out all aspects of the sepsis 6 bundle within the ED
As part of our ongoing Improvement work within ED we plan to review/improve our care of
deteriorating and/or septic patients. To enable us to understand staff’s understanding and
learning needs please complete the following questionnaire. This should then be returned to
Sadie or Kimberley. Many thanks.
Caroline or Yvonne B.
Thank you for taking the time to complete.
Please answer yes or no to each question YES NO UNSURE COMMENTS
. 1. Are you confident with the triage process?
. If no do feel further training would be of benefit?
2. If a patient scores high on NEWs are you
confident with the escalation process?
If no do you require further training?
3. Have you completed a PGD for
administration of fluids?
4. Are you confident inserting a venflon?
If no do you require further training?
5. Are you confident taking bloods?
If no do you require further training?
6. Are you confident taking blood cultures?
If no do you require further training?
7. Are you confident taking ABG’s?
If no do you require further training?
8. Are you confident with the administration of
IV AB’s?
If no do you require further training?
Overall how well do we identify and initiate treatment of deteriorating patients?
Please circle appropriate answer
A I think we do it very well
B I think we do it well but could improve
C I think we could improve
Improved Staff confidence/competencies to assess deteriorating patientsOur aim here was to develop new structured documentation within the resus bay to support nursing staff to carry out an A-E assessment of deteriorating patient’s. This is currently being tested in the ED. Additionally we carried out a confidence score to identify staff learning needs.
Improving journey and imaging process for out of hours patients
Ayr Hospital Emergency Department Creating a culture of quality in the ED - making quality improvement everyone’s business
University Hospital Ayr
Emergency Department Triage
NEWS SCORE
Is it 4 or more?
Refer to Nurse led Sepsis 6 Identifiers
YES NO
Does the pt have a score of 2 or more accompanied
by +ve or presumed infection?
YES
NO
Triage pt as orange – contact nurse in charge or nurse co-ordinator
Immediately begin sepsis 6 bundle
STOP AND THINK!
Continue normal triage process
University Hospital Ayr Emergency Department Nurse Led Early Identification and Delivery of Sepsis Six Bundle
• If score is 2 or more and accompanied by positive or presumed infection then this patient has SEPSIS - triage as orange – inform the nurse co-ordinator.
• Implementation of Sepsis Six Bundle must be completed within one hour. • Vital signs require to be measured every 15 minutes throughout this episode. • Reassessment is required at 1 hour of initiation- are there signs of organ dysfunction, BP systolic < 90 after fluid
challenge, urine output <0.5mls/kg, O2 needed to keep sats >90%?
Is NEWs > 4? Could this be due to Infection and/or does
patient look sick?
Yes but source unclear at present
Pneumonia
UTI
Abdo pain or distension
Cellulitis/septic arthritis/infected wound
Device-related Infection
Meningitis
Recent Chemo/immuno compromised
Other (specify)....................................
Identification Criteria Met Time......................
YES because at least 2 of the below:
Systollic <90
Temp >38.3
Temp <36
Heart rate >90/min
Resp rate >20/min
Acutely altered mental state
Blood Glucose > 6.6 in absence of diabetes
NO as less than 2 of the above
Early signs of improvement have been noted since the introduction of staff competency framework/training. This is an on-going programme with many staff still to complete.
0
10
20
30
40
50
60
3/7/
17
10/7
/17
17/7
/17
24/7
/17
31/7
/17
7/8/
17
14/8
/17
21/8
/17
Tim
e in
Min
utes
Date
UHA EDTriage To X-Ray Time
(Baseline)Median
0
10
20
30
40
50
60
70
80
12/1
/17
12/8
/17
12/1
5/17
12/2
2/17
12/2
9/17
1/5/
18
1/12
/18
1/19
/18
1/26
/18
2/2/
18
2/9/
18
2/16
/18
2/23
/18
Tim
e in
min
utes
Date
UHA EDTriage to Xray Time Median
Early signs of improvement have been noted since the introduction of staff competency framework/training. This is an on-going programme with many staff still to complete.
0
10
20
30
40
50
60
3/7/
17
10/7
/17
17/7
/17
24/7
/17
31/7
/17
7/8/
17
14/8
/17
21/8
/17
Tim
e in
Min
utes
Date
UHA EDTriage To X-Ray Time
(Baseline)Median
0
10
20
30
40
50
60
70
80
12/1
/17
12/8
/17
12/1
5/17
12/2
2/17
12/2
9/17
1/5/
18
1/12
/18
1/19
/18
1/26
/18
2/2/
18
2/9/
18
2/16
/18
2/23
/18
Tim
e in
min
utes
Date
UHA EDTriage to Xray Time Median
Early signs of improvement have been noted since the introduction of staff competency framework/training. This is an on-going programme with many staff still to complete.
