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Description
As part of a our mini-series looking at emergency care through the lens of coronavirus, this episode of CQC Connect, the podcast from the Care Quality Commission, focuses on flow.
Featuring guest host Dr Katherine Henderson, President of the Royal College of Emergency Medicine, we talk about the challenges of the initial phase of the pandemic; share learning and innovation; and hear from clinicians who have been on the front line.
Recorded in November 2020.
Listen to more podcasts from the CQC: https://soundcloud.com/carequalitycommission
Find out more information about the CQC and how it regulates health and social care in England: https://www.cqc.org.uk/
B
Hello,
my
name
is
catherine
henderson
and
I'm
president
of
the
royal
college
of
emergency
medicine
and
I'm
pleased
to
be
the
guest
host
of
this
episode
of
the
care
quality
commission's
podcast
cqc
connect.
This
podcast
is
part
of
a
mini
series
looking
at
emergency
care
through
the
lens
of
a
coronavirus,
we're
talking
about
what
the
challenges
have
been.
Sharing,
learning
and
innovation,
and
hearing
from
clinicians
who've
been
at
the
front
line.
B
Now
flow
was
a
problem
before
the
pandemic
and
is
likely
to
be
a
significant
problem
going
into
winter
on
the
basis
of
a
second
wave
of
chronovirus
as
well
so
flow,
meaning
patients
moving
through
the
system
is
vital
to
patient
safety.
At
the
moment,
I'm
joined
by
two
members
of
the
cqc's
national
emergency
medicine,
specialist
advisors
forum
and
I'm
going
to
get
them
to
introduce
themselves.
So,
let's
start
with
carol
hello.
D
B
C
Found
that
during
the
surge
of
covid,
our
flow
was
much
improved
within
the
department
and
we
had
fewer
numbers
of
attendances,
but
also
we
had
increased
bed
capacity.
So
patients
who
needed
admitting
were
able
to
move
very
quickly
to
an
inpatient
bed,
and
I
think
that
illustrated
that
what
we
need
to
get
the
flow
right
is
the
righty
state.
We
need
space
which
we
had
because
there
were
fewer
patients.
D
So
it's
actually
happened
in
2016
and
it
was
the
the
trust
board
amongst
themselves,
decided
that
they
would
not
be
happy
to
see
their
family
or
their
relatives
sitting
in
a
corridor
in
a
bed
in
ed
waiting
to
be
admitted,
and
they
felt
that
if
it
was
not
good
enough
for
their
family,
then
it
shouldn't
be
good
enough
for
our
patients
and
at
that
time
they
decided.
They
were
going
to
do
something
trustwide
to
make
sure
that
patients
didn't
sit
in
our
corridors.
B
C
B
And
some
examples
I
mean
you
gave
some
general
flow
techniques
of
you
know
watching
flow.
But
have
you
got
any
examples
of
some
good
practice
that
have
meant
that
particular
patient
groups
can
move
through
the
system
either
having
to
come
up
the
ed
or
even
not
having
to
come
through
the
ed?
We
managed
to
develop.
D
Some
very
good
streaming
pathways,
literally
from
the
front
door
of
ed,
so
a
nurse
would
assess
if
they
hit
certain
criteria.
They
were
streamed
directly
to
a
specialty
team
and
we
also
managed
to
do
that
with
quite
a
few
of
our
pediatric
attendances.
D
One
way
of
making
that
a
lot
safer
was
introduction
of
ed
passport
so
that
even
if
patients
had
come
through
to
ed
and
we'd
actually
initially
assessed
them,
but
we
rapidly
realized
that
they
were
safe
to
be
admitted
under
a
specialty
team,
because
there
was
no
way
they
were
going
home.
We
developed
this
passport
which
just
ensured
that
the
minimum
safe
things
were
performed
before
they
left
the
ed
making
sure
they
had
prescriptions
for
all
their
trying
critical
medications.
D
B
That's
very
interesting
because
that
fits
with
the
concept
of
ready
to
progress
or
ready
for
ward,
which
is
obviously
something
that
we're
looking
at
closely
at
the
moment.
Did
that
come
about
because
you
agreed,
you
know
as
a
team
that
that
was
the
the
way
to
move
a
patient
on
safely
and
did
you
have
to
get
a
lot
of
other
people
to
agree.
D
D
It
was
agreed
sort
of
clinical
leads
clinical
directors,
so.
B
That's
a
very
practical
way
of
reassuring
inpatient
teams
that
a
patient
is
ready
to
progress.
That's
agreed
clinically,
which
obviously
is
going
to
be
something
that's
very,
very
important,
going
into
this
winter,
that
we
don't
have
patients
hanging
about
for
a
long
time
in
the
emergency
room
because
of
the
risks
that
that
involves
carol.
Have
you
got
any
other
examples
of
pathways
that
have
worked
particularly
well
that
you're
aware
of
yes.
C
One
of
the
pathways
that
we
implemented,
which
worked
very
well
during
covid,
was
that
we
developed
a
mental
health
assessment
unit
with
the
mental
health
liaison
team,
which
was
actually
based
outside
the
ed
in
the
in
another
area
of
the
hospital
site.
So
that
meant
that
patients
who
presented
to
the
ed
with
mental
health
problems
but
who
didn't
have
any
medical
needs
could
be
seen
and
assessed
by
mental
health
staff
in
a
specialist
assessment
area.
C
They
were
seen
quicker
and
because
it
was
a
much
nicer
environment,
they
were
less
likely
to
abscond
before
being
seen.
So
that
worked
very
well
during
the
search.
Unfortunately,
that's
now
stopped,
so
it's
something
that
we
hope
to
be
able
to
develop
in
future
to
address
these
issues
of
crowding
in
the
long
term,
but
also
the
quality
of
care
for
those
patients
as
well,
which
I
think
was
much
improved
by
that
pathway.
B
I
was
just
going
to
ask
you,
you
know:
was
the
funding
continuing
because,
of
course,
that's
one
of
the
the
issues
is.
How
do
we
maintain
the
flow
things
that
happened
during
covid
when
they
were
rather
specially
funded
or
involved
moving
staff
from
one
location
to
another
location
which
some
of
these,
the
the
crisis
assessment
units
in
mental
health
stores,
a
problem
that
they
were
moving
acute
staff
into
a
different
environment?
B
But
it's
definitely
something
that
we
need
to
evaluate
and
appreciate
if
it
works,
try
and
encourage
that
to
be
a
long
term,
and
it's
not
just
about
the
infection
control
risk,
it's
also
about.
Actually,
it
is
a
better
patient
experience
and
I
would
say,
certainly
from
the
you
know
the
college
point
of
view
promoting
routes
that
don't
come
through
the
department
at
all
is
one
of
the
challenges
for
organizations,
but
if
you've
got
that
buy-in
to
say
actually
not
everything
needs
to
come
through
the
department.
B
That
is
a
really
good
route.
Now
we
may
not
always
know.
What's
on
offer
is
one
of
our
problems.
We
don't
know
what
we
don't
know,
but
finding
out
what
the
alternative
routes
are
can
be
very
useful.
Your
renal
team
may
well
have
the
roots
of
access
that
the
emergency
department
don't
know
about,
but
could
actually
direct
patients
to
if
they
did
know
about
from
the
front
door.
At
times
the
patient
may
have
just
turned
up
forgetting
that
they
could
have
access
care
through
that
environment.
B
So
it's
been
pretty
tough
overall,
I
think
the
last
few
months,
that's
you'd
have
been
very
clear
that
we
need
to
try
and
hang
on
to
things
that
are
have
worked
well.
What
would
your
advice
be
to
help
departments
now
facing
what
they're
facing
getting
busier?
Having
coveted?
What
would
your
top
tips
be
to
trying
to
make
this
work
carol?
Let's
start
with
you.
Well.
C
C
Try
to
you
know,
get
them
on
board
in
seeing
what
the
improvements
in
care
were
during
the
covid
surge
and
how
we
can
go
forward
and
sort
of
develop
those
as
we
go
on
and
work
with
your
multi-specialty
colleagues,
because
I
think
there
were
benefits
for
everybody
for
the
teams
outside
the
ed,
as
well
as
the
ed
staff
and
most
of
all,
the
patients
for
having
these
joint
pathways,
where
the
agreement
is
based
on
best
patient
care
and
getting
the
patient
to
the
right
person
as
quickly
as
we
can.
D
Go
on
your
thoughts
yeah
same
as
carol
in
terms
of
it
must
come
from
the
top
of
the
organization,
but
I
think
there's
also
an
opportunity,
particularly
with
the
you
know,
the
one
one
first
development
for
us
to
engage
much
more
closely
with
our
colleagues
in
the
specialties
in
the
hospital
to
develop
these
pathways.
It's
got
to
be
done,
it's
kind
of
national
mandate.
This
is
our
opportunity
to
really
seize
this,
and
you
know
make
the
most
of
that
opportunity
so
that
we
can
minimize
the
amount
of
time
patients
spend
in
eating.
B
Right,
thank
you.
So
I
think
we
we're
agreeing
that
there
is
something
about
the
input
side
which
is
trying
to
make
sure
that
the
right
patients
are
coming
through
the
department
so
that
they
get
the
benefit
of
what
em
physicians
have
to
offer
in
terms
of
management
skills,
and
some
of
that
is
by
getting
patients
into
alternative
access
points.
Some
of
it
is
supporting
the
one-on-one
work,
and
I
think
you
know
I
I
would
say
with
a
narcam
hat
on
you
know,
ambulance
offloads
is
a
priority.
B
We've
got
to
be
able
to
upload
our
ambulances,
and
but
I'm
really
worried
that
we
will
start
seeing
corridor
care
come
back.
What
would
your
advice
be
to
a
clinical
lead,
who's
eyeing
up
their?
You
know
their
their
tracking
screen
and
can
see
that
the
next
ambulance
that
arrives
is
not
going
to
have
a
cubicle
for
that
patient
and
that
could
be
an
elderly,
vulnerable
patient,
but
they've
got
five
or
six
patients
who've
been
in
the
department
for
a
long
time,
waiting
for
a
ball
waiting
for
a
bed.
How?
B
D
Already
have
a
you
know,
an
expectation
that
we
are
escalating
straight
up
the
chain
to
an
exec
who's
on
call
for
the
day,
and
I
think,
if
we
really
looking
at
that
situation,
they
would
be
involved
in
that
process
already.
They
are
just
not
going
to
tolerate,
not
uploading
an
ambulance.
That's
you
know.
It
goes
back
to
the
old
ethos
of
not
having
a
patient
in
the
corridor.
They
will
not
tolerate
us
not
being
able
to
offload
somebody.
It
comes
from
the
top
yeah.
C
We
we
actually
have
had
a
flow
manager
since
the
end
of
covid,
because
when
we
saw
patients
coming
back
and
potentially
crowding
coming
back,
the
exec
have
now
put
a
flow
manager
into
the
department
who's
based
in
the
department,
any
problems
with
escalating
patients
moving
towards
she's
on
it
straight
away.
It
removes
the
sort
of
bonus
on
the
emergency
department
staff
to
try
and
chase
the
beds
and
chase
the
other
specialties.
C
D
C
And
a
visible
presence
of
the
senior
managers
in
the
department
as
well,
so
they
can
actually
see
on
the
ground
what's
happening
because
often
just
looking
at
a
tracking
board
or
a
screen
in
an
office
doesn't
really
convey
the
actual
nature
of
the
crowding
and
the
issues
that
we're
facing
so
having
them
physically.
There,
I
think,
is
really
important
and
has
been
a
big
sort
of
step
change
in
how
we've
been
able
to
achieve
clear
corridors.
B
D
About
the
culture,
the
culture
of
the
organization
which
is
driven
from
the
top,
which
is
that
we
will
not
tolerate
having
patients
in
corridors
and
similarly
won't
tolerate
patients
being
stuck
in
the
back
of
an
ambulance,
because
we
can't
offload
them.
And
so
when
we
go
through
our
escalation
pathways
and
we
involve
the
site
managers
and
then
the
duty
managers
and
finally,
the
exec
on
call
those
people
expect
to
be
called.
And
they
are
very
happy
to
attend
the
department
and
the
hospital
and
make
things
happen.
Even
if
it's
three
o'clock
in
the
morning.
B
Thank
you,
I
think.
That's
that's,
probably
the
single
message
of
this
podcast
that
maintaining
flow
takes
effort
and
it
takes
commitment,
and
it
absolutely
requires
buy-in
from
the
organization
as
a
whole,
but
most
particularly
it
requires
buy-in
from
the
trust
executive
to
make
sure
that
every
step
that
needs
to
be
taken
is
taken
in
the
timely
way
and
going
into
this
winter,
which
I
think
we're
all
feeling
somewhat
nervous,
about
put
it
mildly.
The
thought
of
having
increasing
numbers
a
second
wave
of
covid
flew
all
the
work.
B
That's
happened
to
be
done
to
try
and
keep
nhs
services
going
and
the
inevitable
loss
of
capacity
because
of
the
requirements
of
social
distancing
is
a
worry,
but
we
have
to
address
this
head-on.
Otherwise
we
are
just
going
to
run
ourselves
into
trouble.
So
thank
you
very
much
indeed
for
participating
in
this.
It's
been
really
interesting
to
hear.
What's
going
on
and
your
reflections
on
what's
going
well
and
very
grateful
to
you
for
taking
the
time
and
thank
you
all
for
listening.