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Managing patient flow at Derby Teaching Hospitals NHS Foundation Trust

Case study: Derby Teaching Hospitals NHS Foundation Trust provides both acute hospital and community based healthcare services, serving a population of more than 600,000 people in and around southern Derbyshire.

It runs two hospitals: the Royal Derby Hospital, which incorporates the Derbyshire Children’s Hospital, is a busy acute teaching hospital.

London Road is the Trust’s community hospital. Its community services are based in health centres and GP practices across southern Derbyshire, providing care to patients in their own homes. 

The Royal Derby Hospital is the newest hospital in the East Midlands and was officially opened by the Queen in April 2010. The trust treats a million patients each year and its busy emergency department sees around 320 patients every day. According to chief executive Sue James, the winter of 2012/13 was a bad time in the emergency department.



We were crashing and burning as far as targets were concerned. Consultants were worried about safety in the department and some were critical of the fact that the hospital was awash with emergency department patients.

Sue James

Chief executive, Derby Teaching Hospital NHS Foundation Trust

At that time safety and patient experience was the main concern, so the trust held a summit with all the key players, including social services, GPs and doctors from the ED and emergency medicine.

An urgent care board was created, which has ended up transforming the way the trust works. They were ahead of their time, with many trusts following this style of working some 12 months later.

It was clear everyone needed to work together – both in the hospital and the community - and it was not just about the emergency department. The care system was transformed by focusing on four major work streams: keeping patients out of hospital, working in the department itself, managing flow through the hospital and discharging patients. Crucially, each work stream is led by a consultant and the urgent care board is chaired by a GP.

To ensure that patient flow is continuous, the hospital developed a range of systems around daily board rounds. Everything that has happened to the patient is recorded on electronic whiteboards. Consultants and teams spend half an hour on this each morning. This is backed up by training to ensure a consistent approach.

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