New methodology making a difference to hospital patients arriving by ambulance

A quality improvement project in Cork has made substantial improvements to ambulance turn-around times

Improving the quality of care is the focus of the RCPI’s postgraduate certificate in quality improvement (QI) leadership in healthcare. An example of the improvement made by the 19 teams that recently completed the course is a project from Cork University Hospital, which has made a substantial difference to people who arrive by ambulance to the hospital.

Dr Jonathan Costello, Consultant, Emergency Department; Ms Aideen O’Riordan, Unscheduled Care Manager; and Mr Brendan Leahy, Operations Manager, are the team behind an innovative new project titled ‘A Regional Approach to a National Challenge; Applications of QI Methodology to Improving NAS TAT KPI’.

The project was presented at the final course sessions at No 6 Kildare Street on 13 and 14 June 2023.

Detailing the project, Mr Leahy explained: “The problem we encountered and the reason for the project was that ambulance turn-around times were ranging from two hours to six hours in Cork alone. We had ambulance shortages, we had staff not finishing on time, and we had staff shortages for morning and evening shifts. We really had to look at it, gather the data and answer the following questions: Why was this happening? What was causing the delays? What could we do to fix it?”

The overall goal of the team is to reduce ambulance turn-around times to an average of 30 minutes on a consistent basis. The team is working towards this aim through a variety of different methods as part of their participation on the course and have already seen some positive results.

Project group

The team set up a project group, consisting of representatives from the core disciplines of nursing, medicine, paramedicine, business management and administration, and appointed a project manager.

Communication

Staff buy-in across all departments was key to getting the project off the ground and good communication was at the heart of this. The team issued staff surveys to get anonymous feedback on where the critical problems were occurring and generate ideas on how to resolve them.

Data

The team reached agreement on how to address the issues facing them. They defined their SMART (specific, measurable, achievable, relevant, and time-bound) aim, created baseline process mapping, and defined a stakeholder influence map. They then mapped their projected activities and goals across a Gantt chart. Weekly reporting was implemented to drive workstream efficiencies and keep the team on track.

Hospital Ambulance Liaison Person

The introduction of the Hospital Ambulance Liaison Person (HALP) has been a successful addition to the hospital. The HALP is on hand to aid ambulance crews in the handover process of patients being admitted into the hospital, focus on potential delays, and assist in maintaining staff wellbeing and monitoring concerns.

Staff wellbeing

The team also took measures to improve staff wellbeing. Mr Leahy explains: “From the ambulance team perspective, we were having delayed finishes and people were exhausted. It has now turned around completely. We also set up a new catering facility to ensure staff were getting their respite and having a chance to eat before getting back on the road again.” 

The results

Revealing the results during the event, the team stated: “Our QI initiative has demonstrated an overall percentage improvement of 49 per cent in four months (to end March 2023). The current mean average for May/June 2023 is 45 mins (down from two-to-six hours).”

They added: “Our work has enabled a local cultural shift in accountability and has attracted national interest. It demonstrates the value of multidisciplinary co-production in managing clinical risk and driving systemic efficiencies, based on QI methodologies.” 

Speaking on the success of the project, Dr Costello said: “We have been mentioned in the Oireachtas as an example of good practice within a short time frame on a zero budget.”

Dr Costello highlighted the next key steps for the group will be to carry out a cost benefit analysis, further engage with the patients to establish their expectations for wait times and to present the project at the Oireachtas. 

“We want to use this as a national template. It’s not about badge collecting or ego. This is about sharing successful learnings within a system. I think Ireland could be the first to crack this issue,” he said. 

Dr Peter Lachman, Lead Faculty Quality Improvement Programme at the RCPI, reflected on all the recent success stories from participants of the postgraduate certificate in quality improvement leadership in healthcare.

The programme takes a team and project-based learning approach and is designed to provide learners with leading edge knowledge and skills in aspects of quality improvement, implementation science, patient safety, and enhanced leadership capacity. Now in its 25th cycle, the programme has seen approximately 700 people from around the country take part.

“We’re developing leaders in quality and safety for the health service. That’s the main aim. While participants are doing the course, they are making a specific improvement within their hospitals,” Dr Lachman stated.

“Participants learn about leadership. They learn about themselves. They learn about working as part of a team. They learn about quality improvement methodologies and tools and techniques. When they put it all together, they become better clinicians and a better team.”

Dr Lachman praised the quality of the presentations at the event, stating he was “quite astounded by the poster presentations”.

“It’s really quite phenomenal when you look at what participants have achieved,” he added. “You just have to look at these projects being presented here today, and they have done it all under the high demands of the service. We’re teaching them to reach their maximum potential and to make a difference.” 

Dr Lachman promised that the experience participants will receive is invaluable, explaining: “It’s an experience that you have to put some time into, but what you get out of it is so much more valuable.”

“If you’re a clinical team, working in any service, either in the community or the hospital sector, and you want to make a difference for the people you care for or for your fellow staff members and team members, this is the course for you.”

For more information on the postgraduate certificate in quality improvement leadership in healthcare, visit https://courses.rcpi.ie/product?catalog=Postgraduate-Certificate-in-Quality-Improvement-Leadership-in-Healthcare.

This article was produced by the RCPI.