Nic Harrison

Nic Harrison

Northern Devon Healthcare NHS Trust

Optimising patient flow in A&E


By developing a comprehensive model of patient journeys, this project has improved both wait times and admission rates in the emergency department.

Northern Devon Healthcare NHS Trust had already identified the need to improve the flow of patients through their emergency department. The HSMA programme allowed them to place operational research at the heart of their project, and help one of their top analysts, Nic Harrison, to deliver lasting impact.

Using the HSMA programme’s structured support, Nic was able to build a simulation model to assess how a new Emergency Assessment Unit might affect the flow of admissions. The team took a holistic view, considering the emergency department in the context of the wider hospital system.

“Our overall aim was to improve performance against our four-hour target, getting emergency department patients seen as quickly as possible. This means patients are treated in the right place at the right time - benefitting both patients and the running of the hospital.”

With the model’s power to inform decision-making coming into focus, the Trust expanded the scope of the project to include assessments of staffing and patient pathways.

Through an iterative series of analyses and discussions with teams across hospital departments, Nic began to create an optimised set of recommendations. Amongst them, was the clear finding that the Emergency Assessment Unit would be most effective if implemented as separate medical and surgical units.

The project’s impact was profound. Despite a 6% growth in attendances, the Trust was able to meet the four-hour standard for waiting times in the first, second and third quarters of 2016 - a performance in stark contrast to deteriorations in national figures.

A narrow miss in the most challenging fourth quarter was close enough to meet regulator requirements and continued model analysis provided evidence that investment in doctor staffing levels could make these achievements possible in quarter four - a time period where 95% of Trusts fail to meet targets.

These performance improvements also brought financial rewards for the Trust, providing further funds that could be invested in improving patient care.

And the benefits didn’t end there, Northern Devon Healthcare NHS Trust were able to share both the methods and findings from their operational research with six other Trusts, laying the foundations for the benefits of modelling to be realised in other locations.

Nic believes embedding an HSMA in one of the Trust’s core programmes of work has been central to delivering effective change:

“The addition of a HSMA has helped to put an evidence-based approach at the heart of the way the Trust makes decisions. We’ve been able to reap the benefits of this way of working with areas outside of the emergency department, extending our work to impact decisions on ward numbers, cardiac treatment and eye care.”

Nic’s work as a Health Service Modelling Associate has also involved him becoming an ambassador for operational research. Raising awareness of his work and its impact has helped to create cultural change at a senior level, helping to join up the way different teams work together to achieve Trust priorities.