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00:00We're back in the new emergency department, which has been open 100 days now.
00:04It's been a bit of a tricky period, how has it all been?
00:07So I think what this has enabled us to do, and having the new emergency department,
00:11has enabled us to manage our trickiest period in a different way.
00:15And actually, because this has led to a whole hospital change and a whole system change,
00:22we've worked really closely with our partners, we've worked really closely with the rest of the hospital department behind,
00:28to make sure that we can try and as much as possible move people through to the right place
00:33and make sure that we're moving people out of the emergency department
00:36so that people in here are being managed where and how they need to be.
00:41So how much of a benefit has it caused to have this new emergency department?
00:45So if you faced these circumstances this time last year, how much of a benefit has it been?
00:49So one of the main, I mean I think there's probably three main benefits,
00:52well there's more than three, but of the highest ones,
00:55the main benefit I think is our sickest patients are being seen much quicker than they were before,
01:00and that's because of our new, the new resource area for our sickest patients,
01:06and that's bigger, and you know, was designed for that.
01:09And we knew beforehand that we were struggling to see those sickest patients in a timely way,
01:14and this has allowed us to really reduce the amount of time that it's taking for us to see them.
01:18That's for adults, clearly that's the similar for children because they now have their own resource areas as well.
01:24I think the other thing that this has really done, as I said, was bring the whole hospital together
01:28and the whole system together in a way of how do we actually work much better together,
01:33and it's improved our relationships and therefore we're starting to see some different changes of practice because of that.
01:39Hi, my name's Vicky, I'm one of the ED matrons for Portsmouth Hospital.
01:44And I'm Kerry, and I'm also one of the matrons in the emergency department.
01:49So obviously it's a new emergency department, it's been open 100 days now.
01:53Obviously it's been a tough, tough period, but how's it been for you guys?
01:58In the beginning it was really exciting because it's really nice to be a part of something iconic,
02:04and we've been through the whole build process together.
02:08We were involved in lots of the ideas, so the way we work, we've really been involved in a lot of it.
02:15Open day was really good.
02:19We've had teething problems, and I think you're going to have that everywhere you are.
02:23The biggest thing for us is that we didn't realise the scale of the department,
02:28so we wanted to come in a bit earlier and do some mock run-throughs of things, and we weren't able to do so.
02:35But I think the team have done really well, and we're still learning, still developing.
02:41But yeah, it is a really nice environment.
02:44I think it's just exciting to finally be here as well, after lots and lots of planning.
02:49We're now in our new department, which is really exciting, and really exciting for the staff as well.
02:55And as one of the paediatric children's matrons, we've got a lovely new department as well,
03:01which is great obviously for the children who come to the emergency department too.
03:05But no, it's lovely to actually finally see it in the flesh, so to speak.
03:10So yeah, it's been really good.
03:12Obviously, the first couple of days have been a bit of a challenging period of winter,
03:16with the influx of flu and a high volume of patients.
03:20How's staff morale been during that time, because it's been very difficult?
03:25I'd say it's been up and down.
03:27I'd say this is one of the strongest teams that I've ever worked with,
03:30and we recently held some interviews, and we asked them what resonated with them within the department,
03:37and every single one of them said how strong the team was.
03:40I think everywhere you go, morale's up and down, depending on time of day, situation and stress.
03:46We are under quite a lot of pressure, but we do our best to try and keep everyone's spirits as high as we possibly can.
03:53We are visible all the time, so we're down here with them.
03:56We literally work alongside them, making sure they're okay, getting their breaks, etc.
04:00So yeah, whilst not everything's always going to be amazing,
04:04everyone does their best to try and keep everyone's spirits as high as they can.
04:08As Picky said, they are a great team. We're a really resilient bunch as well.
04:12We obviously have the highs and we have the lows, but I think as a team we work really well together,
04:18and I think that's what keeps us going through the difficult times.
04:22Obviously, this year the flu cases have been higher initially than they were last year,
04:26but for instance, say, if you were still in the old department, do you think it would have been managed differently?
04:32Do you think this has been beneficial, you've been able to manage it better in the new department?
04:35I think, certainly from one part of the new department, it's obviously now for our major treatment area, for example,
04:41so they're in cubicles, so certainly from an infection prevention point of view,
04:46robust care for our patients in cubicles, which the layout of the department as well is a lot more beneficial
04:52with regards to flu and other infections that we have as well.
04:58So, we spoke to you previously, just before the emergency department opened, and now 100 days later.
05:05Obviously, it's been a difficult period, but how's it all gone?
05:08Yeah, I mean, you say it's been a difficult period.
05:11Winters always are in emergency departments across the country, but it's a fantastic new department, as you can see,
05:19and it's had a lot of benefits for our patients.
05:23Ambulance holds and waiting ambulances, a lot of that has disappeared,
05:27and partly that's because of the building that we've done, and partly because that's the models of care that we have.
05:33There's still a lot of work to do.
05:35The department is often overcrowded, and there's a lot, through the patient journey from pre-hospital to almost discharge,
05:43that can impact that overcrowding in the emergency department,
05:46and it's something that we're striving to do as an organisation, and indeed a system, to get right, to improve patient flow across the pathway.
05:53Yeah.
05:54And you still took on those challenges and those teething problems,
05:57but how much different do you think it would be from if you were in the old emergency department to now, this winter?
06:04I mean, vastly different.
06:06I mean, to be able to get all the ambulances inside in a timely fashion,
06:11to prioritise the sickest patients and get senior decision makers in front of them as soon as possible,
06:16and the environment that we're working in is far better for patients and staff.
06:22Our resuscitation room is double the size, so we've been able to see our sickest patients much, much quicker than we used to be able to.
06:30And yeah, the whole patient journey and staff experience through the new emergency department is much improved.
06:36You kind of talk about areas that need to be improved. I mean, what kind of areas have you been going to then?
06:41So I think it's about identifying the patients that need the emergency department.
06:46So a lot of people present to the emergency department with non-emergency problems,
06:50and that overcrowds our ambulance and our walk-in demand,
06:54but we're working on lots of different pathways to redirect patients and make patients aware,
06:59and indeed clinicians aware, of other pathways that don't involve the emergency department to reduce overcrowding.
07:05The other issue is, you know, getting discharges in a timely way and social care to get patients out of the hospital,
07:13which means our bedded, more frail patients can move through the emergency department quicker.
07:17These are all work in progress, and it's not just Portsmouth that have these problems, it's problems nationally,
07:23but we're doing our best to, you know, look at those problems and see what we can do.
07:28They're wicked problems, they're not easy to solve, otherwise we would have done it.
07:31And just lastly, obviously, as you say, it's been a challenging winter.
07:34Do you feel like you're coming out the other side now? Are things starting to improve?
07:37I'd love to say we're coming out the other side, but I don't think the other side is near for any emergency department.
07:43I think it's constant struggle of trying to get all these pathways right that I've already described,
07:48and trying to improve flow as much as we can through the department.
07:51There's not an easy fix, otherwise we would have done it,
07:54but we've got a strong leadership team and, you know, resilient staff,
07:59and we're going to do everything we can to make patients safe.