Emergency Care Quality Improvement Programme

The journey –

The purpose of the programme is to improve patient flows, making emergency pathways more efficient and reducing length of stay and number of beds whilst also making care safe, effective and a good experience for patients and staff. By better matching capacity to demand the trust aimed to make sure that patients who didn’t need to be admitted to the hospital could be managed on an ambulatory pathway or a short stay pathway; and that inpatients were swiftly signposted to the right specialty with a clinical management plan and pathway of care that would facilitate an appropriate length of stay.


Key achievements of the Programme include: Rapid Assessment in place in A&E where feasible; average length of stay reduced by 0.6 days; a 28 per cent decrease in length of stay over 14 days; 5 pathways embedded in ambulatory and short stay with another 7 at various stages of roll out; 45 patients case managed at home through a ‘virtual ward’ at any one time; a 3 per cent increase in discharges taking place before 2pm; and monthly levels of patients being seen and treated within four hours at 97 per cent.

Patient setting

In-patient           X Out-patient Community based
Mental health Chronic illness Cross-systems       X


Clinical area

Staying healthy Maternity and newborn Children and young people Acute care        X
Planned care Mental health Long-term conditions End of life


Information, tools and techniques used

Several change management tools and models have been used, most notably some principles of PRINCE2 methodology and a Sarah Fraser model for sustainability.  Lean methodology has also informed the programme and a performance dashboard was developed according to IST specifications. The Emergency Care Programme has also benefited from clear communication strategies within divisions and large-scale direct engagement with staff.



This programme took place in the three main acute sites of East Kent Hospitals University NHS Foundation Trust: Kent and Canterbury Hospital (Canterbury); William Harvey Hospital (Ashford); and the Queen Elizabeth the Queen Mother Hospital (Margate).



The programme started in June 2010.  For the first 18 months, the programme focused primarily on developing the right systems and processes, identifying clinical leaders to facilitate the change and engaging staff.  It is now being refreshed to recognise current achievements and look ahead at the challenges that remain. With systems and processes in place, greater focus is being placed on the cultural aspects of embedding change in the organisation.


Contact details and further information

Karen Miles, Associate Director of Operations, East Kent Hospitals University Hospitals NHS Foundation Trust: kmiles1@nhs.net

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