Adult Community Services

Project

North Early Intervention Community Team (EICT) improvement journey

Lead: Luke Butler, Clinical Service Manager; Vicky Egere, Service Manager

 

What was the problem?

A serious incident occurred in the EICT North team, where a patient died unexpectedly. In response, a hot debrief and a full Patient Safety Incident Investigation (PSII) were conducted with full engagement from the team, in line with the Patient Safety Incident Response Framework (PSIRF).

The investigation identified several key areas for improvement:

• Safeguarding: enhancing awareness and strengthening the referral process.
• Clinical knowledge: improving understanding of the deteriorating patient.
• Communication: creating structured opportunities for team discussions about patient care

 

Aim

By end of August 2024 , the aim is to have no further preventable serious incidents reported for the North Team.

 

What did we do?

• Bespoke National Early Warning Score (NEWS2) deteriorating patient training delivered to EICT citywide by Urgent Care Response (UCR) - since adopted across the Trust and other community services.
• Reintroduced Rehabilitation Assistants (RA) huddles and added to Standard Operating Procedures (SOP).
• Introduced daily multi-disciplinary team (MDT) discussions.
• Staff charter introduced to improve team culture.
• Introduced a team leader of the day rota, with a clear line of escalation, who sat with the team, being more visible.
• Safeguarding team delivered in house training with EICT North and across EICT.
• Triage nurse role trialled – was successful and looking at implementation across the city.

 

What are the benefits for patients (and staff)?

• Having a dedicated triage nurse significantly improved continuity of care and ensured patients were seen more promptly. This led to a reduction in the number of rescheduled visits.
  • The team reported increased opportunities to discuss patients and collaboratively problem-solve complex cases during MDT and RA huddles. This fostered deeper reflection and strengthened team cohesion.
  • As a result of enhanced multidisciplinary discussions, the team was better equipped to identify optimal care pathways for complex cases. This collaborative approach led to measurable improvements in patient safety and outcomes, ensuring that individuals received the most effective and personalised support.
  • Culture: it encouraged staff to embrace change with enthusiasm and provided a clear framework for how they could contribute meaningfully to service development and innovation.
  • Focused training initiatives enhanced staff confidence and competence in handling complex clinical scenarios. This was especially evident in safeguarding practices and the early identification and management of deteriorating patients, contributing to safer and more responsive care.
  • NEWS 2 training was adopted across the trust and added to bootcamp.

 

Measures

• ECIs, which turned green in July 2024 for first time since incident occurred in December 2023.
• Reduction in rescheduled visits.
• Surveys on knowledge of deteriorating patient before and after training - saw an improvement in knowledge and confidence of staff.
• Better safeguarding awareness through more reported incidents (datix) and more calls logged with BCHC Safeguarding Adults team.
• Staff feedback on handovers and the staff charter was positive, and they continued to shape how these discussions took place.

 

Qi Tools used

• Plan, Do, Study, Act (PDSA) cycle.
• Fishbone diagram.
• Driver diagram.

Project

You said, we did, appointment cards.

Leads: Sachin Kaddad, Clinical Team Leader.

 

What was the problem?

Potential misunderstanding and confusion around follow-up appointments.

 

Aim

Improve the quality of how we communicate with our patients and relatives by revising non-utilised appointment card and included other useful service contact details.

 

What did we do?

We as a team also reflected on several possible improvements to our communication in engaging with relatives better in the future including being aware of staff choice of phrase, body language and tone, considering discussing with people, their family members and friends how they wish to be included in their therapy input prior to starting rehabilitation and discuss how best to communicate with them.

• Reflection on improvements in communication.
• Review how patients and relatives are informed about follow-up  appointments.
• Revise non-utilised appointment card and included other useful service contact detail.
• Include QR code for patient or relative to provide feedback via ‘iWantGreatCare’.
• Monitor the increase in the number of FFT per month for each team.
• Staff and Patient survey to collect wider feedback, and any updates required on current appointment card.
• Monitor DNA rate and changes since the Appointment Card is introduced.
• Team feedback on improved appointment.
• Liaison with patient experience team.
• Piloted with small number of patient and collected opinion and feedback.
• Fully Implementation within Therapy HUB from January 2025.
• Regular reminder to utilise appointment card.
• Improvement in the very good responses after appointment card has been introduced.
• No similar concern received so far or negative feedback about appointment card.

 

What are the benefits for patients and staff)?

• Less confusion for patients around appointments.
• Better communication between patients and staff.
• Time saved for staff by not having to answer queries around appointment confusion.

Measures used

• Undertake audit to understand reduction in number of calls in office to chase follow-up appointment.
• Monitor monthly data to understand if there is increased number of FFT for the team.
• Undertake wider audit to know if there is reduction in did not attend’s (DNAs) on follow-up appointments post introduction of appointment card.

 

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Audit.
• Feedback.