University Hospitals of Morecambe Bay NHS Foundation Trust


Emergency department digital front door and patient streaming

3 months

Project delivered in


Frailty pathway and clinical decision making tool deployed


Funding requirement met

University Hospitals Morecambe Bay NHS Foundation Trust

University Hospitals Morecambe Bay NHS Foundation Trust wanted to improve patient flow through the health and social care system.  The Trust received funding from NHS Improvement to enable the identification and implementation of a digital ‘front door’ for patient streaming at the Royal Lancaster Infirmary (RLI) Emergency Department to reduce inappropriate admissions and improve patient flow to community and social care services.

At the commencement of this project, patient streaming within the RLI was directed to an embedded GP within the Emergency Department.  While patient streaming was already part of the triage process, in practice, as few as one patient per session was being streamed in this way and the embedded GP often found themselves operating as an additional A&E resource.

Following research in the market and other patient flow projects underway, the Project Executive decided to look to develop and implement a Comprehensive Frailty Decision Tool and frailty care pathway to support the digital streaming of this cohort of patients.  Castlerigg Consulting was commissioned by the Chief Information Officer from Bay Health and Care Partners to deliver the Comprehensive Frailty Decision Tool into the RLI Emergency Department.

The outcomes successfully delivered by the project included:

Reduced inappropriate admissions of the frail and elderly patient groups

Reduced length of stay for frail and elderly patients admitted

Increased capacity of ED staff to deal with the most appropriate admissions

Reduced breaches of 4 hour wait times for presentations at ED



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