Emergency Department Digital Integration (EDDI)

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.

Challenge

Consequently, there was an urgent clinical and operational imperative 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 primary concern was that an overcrowded emergency department (ED) could lead to the rapid transmission of the severe acute respiratory syndrome (SARS) virus.

To address this problem, a staggered slot booking system was devised to integrate with 111 Online call centres, with the aim of managing overcrowding in EDs to the greatest extent possible.

What we did

Understanding context

In order to establish a solid foundation for the project, close collaboration with a Service Designer and a Researcher was initiated, with the primary objective being the documentation and comprehension of the context of use for the service. EDs are characterised by high levels of pressure, necessitating the integration of the service into the front-of-desk staff's extant processes and activities. Conducting this preliminary research was found to be of paramount importance in ensuring that the proposed solution would cause minimal disruption to the administrative staff who would be tasked with utilising the service.

Designing at pace

The decision to commence work on potential design solutions expeditiously represented a calculated risk, one that was deemed to be justifiable in light of the pressing need to present a functional solution with all possible haste. This was particularly salient in consideration of the intricate nature of the problem to be addressed and the potential clinical risks that would arise from an extended engagement in the research domain.

Utilising remote, collaborative design sessions, a multifaceted journey was devised to meet the needs of a diverse range of users in both clinical and administrative contexts.

The objective of the proposed solution was to enable callers to 111 Online to be allocated a preferred attendance window (or slot) during which they would be expected to visit their nearest ED, contingent on the severity of their emergency. The details of the patients and their recommended attendance times were then presented to ED check-in staff, who would then mark the patients as "arrived" when they presented themselves.

The system also enabled NHS Trusts to manage their own capacity to receive patients, taking into account their specific staffing levels, clinical resources, and other relevant factors. This ensured that our service mitigated the potential for clinical risk in the event that a national or local emergency rendered staggering patient arrivals no longer feasible.

Testing with users

Utilising the NHSD design guidelines as a foundation for our design direction, we proceeded to develop prototypes in Axure for the purpose of engaging with users to validate our ideas. In consideration of the frenetic pace characteristic of EDs, meticulous attention was devoted to the minimisation of cognitive load on the part of the users. To this end, particular attention was paid to ensuring the interface included only vital information and required users to click a single button to action an arrival.

Utilising the feedback derived from these usability testing sessions, the designs were iteratively refined until a solution that would satisfy the requirements of clinicians, administrative staff and patients was rapidly formulated. The path to delivery was now open to us. Utilising annotated design assets provided by the author, the service was successfully implemented and made available for use in an unprecedentedly brief period.

My role

As a consultant working for SPARCK/BJSS, but also alongside permanent NHSD team members and civil servants, my postion was as Lead Designer. My duties included:

Outcomes

Since the launch of the NHS, a notable reduction in overcrowding in Emergency Departments (EDs) across England and Wales has been recorded. The question of whether this has had an impact on the spread of the virus is not easily answered, but it seems reasonable to conclude that the effect has been beneficial. It is also noteworthy that the service has subsequently been subject to a GDS peer review to ensure it meets service standards, which it has passed.