Emergency care and Covid response, Kent 2020

Medway Foundation Trust Hospital


At the end of March 2020 an acute hospital in Kent was completing a major Emergency Pathway transformation programme. Upgrading the site management function had been the cornerstone of this effort.

The shock of Covid made the "traditional" pressures tackled by the transformation programme more intense and increased the complexity of the emergency pathway.

Increased "traditional challenges"

Inadequate out-of-hospital capacity & blocked outflows

  • Increased number of OOH beds required
  • Vulnerable patients need more support in the community
  • Increased pressure to move "medically optimised" patients out of the hospital quickly

High demand

  • Covid patients increase demand for critical care and respiratory beds
  • Decrease in non-Covid attendances is expected be temporary and followed by a 'correction' (i.e. postponed demand)

Low staffing resources and morale

  • Unprecedented demand for staff
  • Sickness rate increases
  • More critical and respiratory care resources needed
  • Rotas need altering for infection control
  • Absent staff due to concerns over a lack of PPE
Additional Covid challenges
  • More complex patient segmentation (Covid cohorts)
  • Live map of capacity reflecting Covid cohorts
  • Live tracking of Covid patients
  • IPC integrated with site operations


Building upon our traditional emergency pathway programme, we supported the Trust with their crisis response to Covid. A fundamental part of the response was an overview of the enhanced site management function under the Covid SOP:

Agreed cohorts of Covid patients, created a live map of where they were in the hospital, and developed the process / criteria to 'step' them down to non-Covid wards

Established Covid patient tracking and reporting, co-creating new processes to develop one version of the truth and facilitating the safe flow of patients

Fine tuned national Covid demand models with input from senior clinical leadership and local variables to better model the pressures on the trust

Optimised existing pathways and agreed new Covid pathways into 3 simple decision-making steps

Drove the operational "battle rhythm", supporting senior ops with critical operational decision making e.g. ward flip plan

Consolidated these Covid decision-making tools to create a "Covid Watchtower", providing a central source of information to support daily critical decision making.


Critical care
critical care beds

Created 75 critical care beds within a week and maintained additional "spare" capacity

Length of stay
patients over 21 days

Reduced in-patient average length of stay more significantly than other local hospitals, with a 62% reduction in patients >21 days and almost all medically fit patients discharged within 1 week.

Infection control

Reported lower levels of nosocomial infections than other hospitals in Kent

Achieved despite experiencing greater pressures (higher attendances and numbers of COVID patients) than other local hospitals.

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