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Accid Emerg Nurs. 2006 Jul;14(3):141-7. Epub 2006 Jun 9.

Modernising chronic obstructive pulmonary disease admissions to improve patient care: Local outcomes from implementing the Ideal Design of Emergency Access project.

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  • 1Respiratory Department, Royal Devon and Exeter Health Care NHS Foundation Trust (Wonford), Barrack Rd, Exeter, Devon EX2 5DW, United Kingdom.


This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.

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