Radical approach overhauls A&E performance of West Hertfordshire Hospitals' NHS Trust

Hemel Hempstead General Hospital is run by the trust

A new government report has named West Hertfordshire Hospitals NHS Trust as the most improved trust in England for its performance against the four hour emergency care standard.

Michael van der Watt

Michael van der Watt

West Hertfordshire Hospitals NHS Trust operates from three hospitals, Hemel Hempstead, St Albans City and Watford General.

Figures from the House of Commons Briefing Paper on NHS Key Statistics, released in February, reveal that patients in the trust's A&E departments experienced the largest decrease in four hour waits compared to the previous year, a six per cent decrease.

The trust says the turnaround is the result of a new way of working, which includes changing how the admission of patients to hospital is managed with the aim of providing a senior decision-maker at a sooner point.

A new approach to assessing patients in A&E is the result of a project called SMART (senior medics assessment, review, and treatment) which has improved the patient experience.

Consultant specialists from three medical teams - acute medicine, respiratory and cardiology - work at the ‘front door’ seven days a week from 9am to 9pm.

Patients now have access to specialist care much earlier in their journey and many can be sent home after review; or to a ‘hot clinic’ to be seen by a specialist or to the ambulatory care unit (for same day care), rather than being admitted.

Early speciality review has also reduced the number of days patients need to stay in hospital.

Dr Mike van der Watt, chief medical director of West Hertfordshire Hospitals NHS Trust, said: “We have fundamentally changed the decision making at the front door.

"As a result there has been a 15 per cent decrease in the numbers of patients admitted in spite of an 11.3 per cent increase in attendances across our three emergency and urgent care sites.

"For those patients who are admitted, we have reduced their length of stay by nearly a day.”

A successful recruitment initiative for A&E doctors means senior decision makers can cover all areas of the department and strengthened leadership across all three of the trust’s urgent care sites means that patients seen at Hemel Urgent Treatment Centre and St Albans Minor Injuries Unit are almost all seen and discharged or transferred within the four hour standard.

With a less crowded A&E, there is a more prompt handover of patients from ambulances which means they are not unnecessarily delayed and can be sent back out to the community to respond to 999 calls.

Dr van der Watt added: “Months of hard work from dedicated, caring and committed teams working collaboratively means that currently we are the only trust in the East of England region delivering an improved four hour performance and everyone benefits.”

To see the full report from the House of Commons Briefing Paper click here.