Maximising space and accessibility at Moorfields Eye Clinic, Croydon Hospital
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Knowledge HubThe new patient pathway saved TACU 66 bed days per month providing the health board with a saving of £1,000,000 over a 2.5 year period.
Prior to the establishment of the Trauma Ambulatory Care Unit (TACU) ambulatory trauma patients were treated through the Emergency Department stream. The existing pathways for non-complicated trauma patients treated in the hospital was based on a historical standard of care, relying on the availability of beds to provide treatment but the beds were often filled with non-ambulant or systemically unwell patients.
The unsuitable environment of no access to a bed, natural light, or refreshments meant the overall patient experience was poor. Feedback was that the area was uncomfortable and detracted from their clinical care. Patients often self-discharged against medical advice directly citing the poor facilities. This in turn compromised their care leading to worse outcomes.
As patient concerns became apparent, the need for an alternative was clear: A facility that could host in-patients, administer care, without the need for an in-patient bed, allow senior medical review, and escalate care to the operating theatre as needed.
To solve this problem the health board introduced TACU and reproduced best practice examples from ambulatory care by streamlining appropriate patients into an ambulatory care pathway, alongside a behavioural mindset change of clinicians to be more “why can’t this be day case?” versus “can this be day case?” This mindset change prompted a fundamental new approach.
The health board and Ocura worked together to select 8 new recliners. Mauro, a compact recliner was selected, allowing patients to have their consultation, treatment, and recovery in one chair. For minor surgery, Verona was selected enabling maximum clinical flexibility.
Simple minor procedures can be performed within the unit itself and when necessary, patients are prepped for theatre and can recover in TACU post-operatively before discharge the same day.
Patients requiring intravenous antibiotics over many days are now attending day visits, the patient can be kept on the antibiotics for the full term without using bed space, resulting in better care for patients.
Patient feedback is universally positive, 82% of patients rated the new facility as “excellent” on a 5‑point scale and stated they enjoy the flexibility that the unit offers.
Before TACU patients coming in via the Emergency Department would have followed the following pathway:
New patient TACU pathway:
Based on a total dataset of 76,265 cases from February 2013 to 15th January 2023 the following was measured pre and post TACU.
For open reduction and fixation surgery:
Pre-TACU average LOS was 87 hours
Post-TACU average LOS is 12 hours
Pre-TACU average LOS was 60 hours
Post-TACU average LOS is 47 hours
A key outcome is that by freeing up these beds, there are more beds available for patients coming in through the Emergency Department, who do need to be admitted. Now only 7% of patients end up requiring a hospital bed overnight.
The unit runs with minimal staff: 1 qualified and 1 non-qualified nurse covering the 8 chair spaces. Recruitment was easy, the staff like the predictable hours and place of work and the unit takes up a small geographical space.
TACU saved 2000 bed days, the equivalent of 66 bed days per month.
The estimated cost per bed per day is £500, providing the health board a saving of £1,000,000 over the 2.5‑year period.
*Data collection period Feb 2020 to July 2023
Ocura’s custom Clini-Store™ solution transforms Moorfields Eye Clinic Utility Room for optimised storage and efficiency.
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