Trauma Ambulatory Care Unit


Oliver Blocker, Clinical fellow in Trauma and Orthopaedics

Ryan Trickett, Consultant Trauma and Orthopaedic Surgeon

Kris Prosser, Finance Officer

Gillian Edwards, Senior Nurse in Trauma and Orthopaedics


Cardiff and Vale University Health Board


This Bevan Exemplar project transformed the model of care for ‘walking wounded’ patients at University Hospital Wales (UHW).


Background


The existing pathways for non-complicated trauma patients treated in hospital in Cardiff was below reasonable standards of care. The healthcare model used was historical, relying on the availability of beds to provide treatment, which combined with an unsuitable environment, led to poor patient experience. We wanted to solve this problem by reproducing best practice examples from ambulatory care in medicine.


Aims


Our aim was to follow the principle of Ambulatory Emergency Care (AEC), which is that a significant proportion of adult patients requiring emergency care can be managed safely and appropriately on the same day, either without admission to a hospital bed at all or admission for only a number of hours. Streamlining appropriate patients into a dedicated ambulatory care pathway is part of the guidance from the Getting It Right First Time (GIRFT) NHS England project that is working to improve Trauma and orthopaedic services. We wanted to transform ambulatory trauma care models in Cardiff, in line with these wider NHS changes and create a new environment for patients in anticipation of UHW becoming a Major Trauma Centre.


Challenges


We quickly realised the ambition of our task but we were determined to adhere to three guiding principles, learned from our medical colleagues:


1. Find the physical space for our new unit,

2. Link our project to existing national projects,

3. Collaborate closely with management at clinical and executive level.


The support given to us by the Bevan Commission allowed us to translate our ideas into practice:

  • Networking with exemplar and finance colleagues showed us how to use the hospital environment effectively.

  • Close team working ‘in house’ and collaboration with national projects towards a shared goal kept our project moving forwards.

  • Adhering to best practice process mapping and patient pathways, as set out by the GIRFT and AEC network project, gave us a framework to adapt to our local needs.

  • ‘Experiential based design’ using patient stories showed how we could improve outcomes and keep costs reasonable in our business case.

  • Engaging with and reacting to social media allowed us to respond to external challenges and develop our project at pace and scale.


Outcomes


Within the timeframe for this exemplar cohort (15 months) we have planned, financed and opened a new unit that is treating ambulatory trauma patients right now in Cardiff. Our goal now is to reassess the patient experience in this new unit and gather impact and patient reported outcome data on the changes we have made to show that we have provided value based healthcare.


Next steps


We aim to spread this project as part of the Bevan Commission ‘Adopt and Spread’ programme to bring this model to Trauma units across Wales.



Part of cohort Bevan Exemplar Projects 2018-19