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Committed teams and radical approach overhauls West Herts' A&E performance

Posted: 5 March 2020

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A new government report has named West Herts Hospitals NHS Trust as the most improved trust in England for its performance against the four hour emergency care standard. The trust says the dramatic turnaround is the result of a new way of working as well as the continued efforts of a skilled and committed workforce.

Figures from the House of Commons Briefing Paper on NHS Key Statistics* reveal that patients in A&E experienced the largest decrease in four hour waits compared to the previous year. The trust has radically overhauled how the admission of patients to hospital is managed with the aim of providing a senior decision-maker at a sooner point. Patients requiring specialty input are treated as quickly as possible and in the most appropriate place.

A new approach to assessing patients in A&E is the result of a project called SMART (senior medics assessment, review, and treatment) which has vastly improved the patient experience as well as leading to national recognition.

Consultant specialists from three medical teams - acute medicine, respiratory and cardiology - work at the ‘front door’ seven days a week from 9am to 9pm. Patients now have access to specialist care much earlier in their journey and many can be sent home after review; or to a ‘hot clinic’ to be seen by a specialist or to the ambulatory care unit (for same day care), rather than being admitted. Early speciality review has also reduced the number of days patients need to stay in hospital.

Chief medical officer Dr Mike van der Watt said: "We have fundamentally changed the decision making at the front door. As a result there has been a 15% decrease in the numbers of patients admitted in spite of an 11.3% increase in attendances across our three emergency and urgent care sites. For those patients who are admitted, we have reduced their length of stay by nearly a day."

A successful recruitment initiative for A&E doctors means senior decision makers can cover all areas of the department and strengthened leadership across all three of the trust’s urgent care sites means that patients seen at Hemel Urgent Treatment Centre and St Albans Minor Injuries Unit are almost all seen and discharged or transferred within the four hour standard.

With a less crowded A&E, there is a more prompt handover of patients from ambulances which means they are not unnecessarily delayed and can be sent back out to the community to respond to 999 calls.

Dr van der Watt said: "Months of hard work from dedicated, caring and committed teams working collaboratively means that currently we are the only trust in the East of England region delivering an improved four hour performance and everyone benefits."

The report which singled out West Herts Hospitals NHS Trust for its improvement also covered the rising number of ‘trolley waits’ – patients who wait more than four hours to be admitted to a hospital bed after the decision is made to admit them. There have been no trolley waits at West Herts for more than three years.


Notes to editors

  1. *House of Commons Briefing Paper on NHS Key Statistics: England, February 2020
  2. For more information, please contact the communications team on: 01923 436280 or email: For out of hours media enquiries please call the Watford General Hospital switchboard on 01923 244366 and ask for the on call communications manager.
  3. West Hertfordshire Teaching Hospitals NHS Trust serves people from across Hertfordshire, north London and further afield. It operates from three hospitals; Watford General, St Albans City and Hemel Hempstead. The trust has a catchment area of over 500,000 people and is one of the largest employers locally, with around 5,000 staff and volunteers.
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