The Immediate Assessment Unit at Queen Elizabeth University Hospital was regularly exceeding its capacity, with attendances often outweighing the available space. Morning attendances tended to have higher acuity and be more likely to require admission. This caused the unit to physically run out of space between 15:00-21:00. A test of change proposed removing 3 beds to create "ring fenced" trolleys for triage category 3 patients and using the seminar room as a sub wait area. Data on patient movements and occupancy was collected through TrakCare to evaluate the outcomes of redistributing space and implementing a "see and treat" model for category 3 patients. The results and analysis aimed to ensure assessment space was available all day

1. Queen Elizabeth University Hospital
Immediate Assessment Unit – Test of Change

2. Immediate Assessment Unit – Background
• Route of attendance is through the GP referral pathway
• In 2018/19 there were 28,667 attendances
• 16,122 Admissions
• Daily attendances range from 140-20
• The unit is made up of 28 bedded bays, 2 triage bays and 1 seminar room
• It cares for Triage Category 2 and Category 3 patients, referred to the unit by their GP
• The Unit has Consultant cover from 08:00-20:00

3. Test of Change Proposal
The Issue Facing the IAU
• The number of attendances regularly outweighs the capacity of the department
• Attendance in the morning tend have higher acuity, are more likely to be older and more likely to
require admission.
• This means the unit physically runs out of space to see and treat patients during its peak
attendance period between 15:00-21:00
Test of Change
• The aim was to ensure the unit had assessment space available throughout the day
• Reduce the time taken to See and Treat, Triage Category 3 patients
• Reduce the overall occupancy of the department
• Reduce time taken to First Assessment
The Proposal
• Remove three of the beds from Bays 22-24 and replaces them with ‘ring fenced’ Trolleys
• Use the Seminar Room as a sub wait area for Triage Category 3 Patients
• Operate See and Treat for Triage Category 3 out of this area of the unit

4. GP ReferralGP Referral
Triage
GAP score
NEWSAECU Bloods /
ECG
EMAT
CAT 3 CAT 2
Seminar
Room
ADMIT
1-11
18-21
25-28
Limited Clerk-In Full Clerk-in
DVT
<25 >25
Consultant Review
Discharge
ANP
Medic
FY1
Middle Grade
Registrar
ANP
Medic
Consultant 3 (1200-1800)
Consultant
1
Registrar
FY1
0800-1900
Consultant 2
(0800-2000)
Back to IAU
or ARU for
admission
Medical Model - Patient Flow - IAU

5. IAU – Floor plan

6. Analysis
3 objectives in completing our Analytical support:
1. The test of change data collection element would be entirely collected through TrakCare
2. The data needed to be understandable and compelling to all staff in the unit
3. It needed to reflect what was actually happening in the department

7. Week 1 Turnover Total mins Occupied Average Stay in mins Daily Turnover
Room 1 24 13132 547.2 2.4
Room 2 17 12918 759.9 1.7
Room 3 22 12632 574.2 2.2
Room 4 20 12207 610.4 2.0
Room 5 27 12614 467.2 2.7
Room 6 25 12638 505.5 2.5
Room 7 28 13950 498.2 2.8
Room 8 26 12534 482.1 2.6
Room 9 25 12573 502.9 2.5
Room 10 21 13666 650.8 2.1
Room 11 25 13679 547.2 2.5
Room 12 387 5263 13.6 38.7
Room 13 220 4961 22.6 22.0
Room 14 146 7672 52.5 14.6
Room 15 109 8801 80.7 10.9
Room 16 82 7929 96.7 8.2
Room 17 65 8743 134.5 6.5
Room 18 31 12995 419.2 3.1
Room 19 23 12738 553.8 2.3
Room 20 23 13897 604.2 2.3
Room 21 28 12251 437.5 2.8
Room 22 38 2994 78.8 3.8
Room 23 45 2899 64.4 4.5
Room 24 29 1968 67.9 2.9
Room 25 30 13312 443.7 3.0
Room 26 22 13323 605.6 2.2
Room 27 30 12494 416.5 3.0
Room 28 33 11806 357.8 3.3
Subwait 199 13871 69.7 19.9
Triage 1 176 1438 8.2 17.6
Triage 2 85 755 8.9 8.5
Movements Data:
Produced for us by our BI Team allows us
to track every patient move in the unit –
with a start and end point.
Giving us a complete picture of the
activity in the department and where it is
concentrated
Movements Data Allows us to See:
• Areas of high and low activity in the
department
• To show room utilisation in the Unit
• Length of stay for each Room
• The turnover rate for each Room
• And calculate room hourly occupancy

8. Immediate Assessment Unit – Movements Data – Occupancy Map
ARU
E N
1.0
Bay 25
0.1
Triage 2
Time 19:00
Subwait Room
1.1
Bay 28 1.0
Bay 27
1.0
Bay 26
Bay 8
1.1
Bay 1
Bay 220.1
0.4 Bay 23
0.1 Bay 24
Medical
Team
1.5
Bay 18
1.1
Bay 19
1.1
Bay 20
1.1
Bay 21
0.9
0.9
NS
Bay 17 1.5
Bay 16 1.4
Bay 15 1.2
Bay 14 1.4
Bay 13 1.9
Bay 12 2.4
1.1
Bay 10
0.8
Flow Co
EMAT
Office
Bay 11
1.1
Bay 5
0.9
Bay 6Triage 1
0.1 1.1
Bay 4
0.8 0.9
Bay 2
1.0
Bay 3
Private
Transport
Arrival
Amb Arrival
REG
Corridor
Waiting
Area
Corridor
Wait
Triage
Notes
Change time of Day by clicking on the tab
ARU
3.5
Bay 7
1.0
CDU
NS
4.2
Waiting Room
Awaiting Bed IAU
ARU
5.1
Awaiting EMAT
Awaiting
Investigrations
0.9
Bay 9

9. The Results

10. Special Thanks to…
Debbie Ambridge
Kevin Begbie
David Bell
Allan Bray
Linda Caldwell
Lorna Dunipace
Carol-Ann Jamieson
Kirsty Mccaffery
The IAU Team