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.