Emergency Department Digital Integration (EDDI)

Helping the NHS reduce clinical risk during the COVID pandemic.

Interaction Design & Research

THE CHALLENGE

During the lockdown period from March 2020 there was a substantial reduction in attendance at Emergency Departments (EDs), and a significant increase in the use of NHS 111 Online. However, the number of patients attending EDs had subsequently been climbing towards pre-COVID levels.

As a result, there was an urgent clinical and operational need to reverse this trend and ensure that during the forthcoming winter the NHS did not experience the levels of overcrowding in EDs that occurred during winter 2019/20. The concern being that an overcrowded ED could result in the rapid spread of the COVID virus.

To address this problem, we devised a staggered slot booking system that would integreate with 111 Online call centers to ensure overcrowding in EDs was managed as much as possible.

WHAT WE DID

Working closely with a Service Designer and a Researcher, we intially set about documenting and understanding the context of use for our service. EDs are intensely pressurised environments in which to work and it was of paramount importance that our service integrated as seamlessly as possible into the front-of-desk staff's pre-existing processes and activities. Doing this up-front research was integral to ensuring our proposed solution caused as little disruption as possible to the administrative staff who would ultimately be tasked with using this service

Jumping into potential design solutions as soon as possible was a bit of a gamble, but a risk we thought was worth taking given the fact we were under considerable pressure to present a working solution as a matter of urgency - moreso given the nature of the problem we were trying to solve and the clinical risks that would present themselves if we were to spend too much time in the research space.

Using remote, collaborative design sessions, we devised a multi-faceted journey that met the needs of a wide range of users in a clinical and administrative context.

Our solution aimed to allow callers to 111 Online being issued with a preferred attendance window (or slot) during which they would be expected to visit their nearest ED, attendant to the severity of their emergency. The details of the patients and their reccommended attendance times were then presented to ED check-in staff who would then mark the patients as "arrived" when they presented themselves.

Our service also allowed for NHS Trusts to administer their own capacity to see patients based on their specific staffing levels, clinical resources etc., thereby ensuring our service mitigated the potential for clinical risk in the event that a national or local emergency meant that staggering patient arrivals was no longer an option.

Using NHSD design guidelines as a basis for our design direction, we developed prototypes in Axure for the purposes of engaging with users to validate our ideas. Given the frenzied nature of EDs, we were careful to ensure we minimised cognitive load on our users. To this end, we paid particular attention to ensuring the interface included only vital information and required users to click a single button to action an arrival

Using feedback from our usability testing sessions, we iterated our designs and quickly arrived at a journey that would address the needs of clinicians, admin staff and patients. The path to delivery was now open to us. Using annotated design assets provided by myself, we managed to get the service live and in use in record breaking time.

OUTCOMES

Since launch, the NHS has recorded a notable reduction of overcrowding in EDs accross England and Wales. Whether or not this has had an impact on the spread of COVID is hard to measure, but I think it's safe to assume that the impact has been positive. It's worth noting as well that the service has subsequently been subject to a GDS peer review to ensure it meets service standards, which it has passed.