by Zoe Jones


Download this Quality Improvement Poster

Background and problem

The variance in time for patient waiting to be seen in the acute medicine department is huge. The Society for Acute Medicine describes a main quality indicator for all AMUs as all patients being seen by a “competent clinical decision maker within 4 hours” If we cannot see patients in a timely manner we cannot provide the correct treatment. In particular I had concern about a specific group of patients who could be categorized as sick by their National Early Warning Score (a total score collating all medical observations such as heart rate etc) being equal to or over 4.

In Gloucestershire Royal we are struggling to meet this and only 60% of our patients with NEWS>4 are seen within the 4hour recommendation.

This project has been conducted in the unscheduled care area of Acute Care Unit A and The Emergency Department for all patients with NEWS >4 on admission to the hospital.


To reduce the time patients with NEWS>4 are waiting to be seen by the medical team by 40% by April 2017.


Snapshot data taken regularly of all patients NEWS on admission, time waiting to be seen by first doctor and time taken too be seen specifically by medicine.

PDPDSA cycles instituted to address such problems as process (highlighting high NEWS on computer system to doctors clerking) changing methods that patients are recorded on medical lists, education for staff on escalation of NEWs scores via simulation training etc.


Has helped increase awareness of need to consider NEWS during nursing and medical clerking and increase culture of escalation of NEWS to medical staff.

No indication that PDSA cycles making significant enough impact as yet. Hampered by strains on the system.


Some PDSA cycles failed due to poor engagement. Change although in small PDSA cycles can help move towards the culture change but may not have significant enough impact in of themselves. Further opportunity for work and hopes that Qi project will meet its target by April 2017. If this works in ACUA opportunities for it to assist practices across the Trust.

Quality Improvement Presenter(s)
Zoe Jones, Chief Registrar, ST6 Acute Medicine
Quality Improvement Team
Markus Hauser (sponsor)
Donna Macklin ACUA Ward Manager
Emily Bowen Chief Registrar
Catherine Tanner Medical SHO and fellow data collector