Senior Medics’ Assessment and Review Trial (SMART) Initiative
West Hertfordshire Hospitals NHS Trust
Andrew Barlow, Divisional Director – Medicine Division
This is an OD initiative, streamlining the journey of medical patients attending emergency departments. It promised and delivered, raising standards of care and giving a better experience for frontline staff. It was so successful that the Trust achieved the greatest national reduction in 4 hour waiting time in A&E.
SMART was a key piece of OD, fitting within the Trust’s strategy of being a clinically led organisation. Divisional directors’ roles were expanded to give them the authority and skills to lead this new OD project.
- 3 consultants – cardiology, respiratory and general medicine – placed in A&E so reducing need to admit patients
- Better faster outcomes for patients, improved performance in A&E, fewer admissions
- Wide impact on services e.g. improving ambulance handovers, reducing re-admissions
- Total success, hugely improving A&E’s performance indicators, best in UK
- Upended traditional model of patient slowly referred upwards by having senior specialist at the door to direct patient on best pathway without delay.
The panel loved this entry involving the entire multi-disciplinary team. The barriers to success were clearly broken down as the impact on patients was clear; a reduction in waiting times and length of stay, meaning that resources could be utilised for other patients. Clinical leadership demonstrated a tangible impact on patient care.