Improvements at North Cumbria University Hospitals NHS Trust

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A ward team at the Cumberland Infirmary in Carlisle dedicated a week to intensive improvement aiming to reduce waste and, in turn, improve patient care by increasing the amount of time the nursing staff spend with patients.


The team on the Emergency Assessment Unit (Larch A/B ward) were selected to take part in a rapid process improvement workshop which is supported by the Cumbria Learning and Improvement Collaborative (CLIC) who focus on positive transformations in health and care. 

The workshop provided an intensive five-day improvement plan and gave staff working on the ward an opportunity to take time out to discuss the main obstacles they face within their day-to-day roles and how these could be reduced as well as to improve efficiencies and provide staff with more time for face-to-face patient care.

What improvements did the trust make?

The team, including medical, nursing, allied health professional staff and a patient representative, quickly identified and implemented a number of improvements which include the following:

  • handovers between nurses will now take place at the patient’s bedside to give them the opportunity to be involved and interact more with the staff
  • there will now be a computer on wheels in every bay so that if nursing staff are filling in necessary paperwork they are still readily available to their patients
  • reducing any unnecessary or duplicate paperwork 
  • aiming to have discharge documentation and any ‘take home’ medications ready within an hour of the patient being ready for discharge
  • aiming to discharge a third of patients ready to go home before midday which benefits the patient who no longer needs to be in hospital and any patients who require a bed

Highlights from the week

It was a very exciting week for our team with the aim of keeping patients at the centre of our attention and improving their experiences. As part of this work, we have introduced bedside handovers which allow our nursing team to develop that initial rapport with a patient as soon as they start their shift.

Emily Dixon,  Ward Manager, Emergency Assessment Unit, Cumberland Infirmary

For me, the most important thing was the focus on early discharges. If we can enable patients to be discharged by midday it is better for those patients and also frees up bed spaces for people who may be waiting for further assessment in our A&E department.

Dr Stephen Wiltshire, Medical Registrar, Emergency Assessment Unit, Cumberland Infirmary

The team also invited along an ‘expert patient’ to observe their work and offer insight from a patient’s perspective. Sue Gallagher, from Port Carlisle, has had a lot of experience of health and care services with her husband Bob who had diagnoses of Parkinson's disease and Vascular Dementia. Bob sadly passed away six years ago and Sue felt that she could use her experiences which ranged from very good to rather disjointed, to positively impact on services in Cumbria.

I feel honoured to have been asked to take part and I have spent time talking to both staff and patients. The first thing I noticed with this team is that there is no hierarchy – people challenge each other in a way that is honest and trusting no matter what their job title and that says a huge amount about the confidence of the team which was most impressive. 

People may think that changes are always made at the top and that staff on the wards are ‘told what to do’. Nothing could be further from the truth from what I have seen last week. The people implementing the changes are the people deciding on the changes. They also stayed very focused on ‘how is this going to be better for our patients’ and ‘how will this give me more time my patients.

I hope that other members of the public will be able to work with hospital staff in this way – it is a real education.

Sue Gallagher, Patient, Port Carlisle

Next steps

The team at the trust will hold 30, 60 and 90 day reviews to ensure all improvements identified are continuing to be implemented.

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