Breaking the cycle

Introduction:

Our ‘Breaking the Cycle Together’ events aim to help us remove blocks and barriers to patient flow in real time, to achieve best patient care, by improving flow throughout the hospital, whilst safely reducing the number of our escalation beds. By removing delays to care for patients, we are able to contribute to improved patient experience and highlight and address delays within our hospitals. Access targets across emergency and elective pathways are maintained at all times.

Approach:

The events are run via a formal ‘gold, silver and bronze’ command process, in accordance with structured guidance received from the Department of Health’s Emergency Care Intensive Support Team (ECIST), following successes achieved in other Trusts.

  • There is a focus on solving problems as they occur as a team.
  • A control and command structure is set up in the Trust to achieve this.
  • The events include partner engagement from Gloucestershire Clinical Commissioning Group, Gloucestershire Care Services, 2gether NHS Foundation Trust and Gloucestershire County Council.
  • These events embed the SAFER bundle across ward areas

Composition of the Teams:

Bronze (ward team): Core ward team, Onward Care Team, Consultants, Senior Registrars, Divisional Directors of Nursing, Matrons, Ward Managers, Lecturer Practitioners, senior AHPs, Directors of Operations, General Managers, senior Corporate Managers and external clinical challengers from our partner organisations.

Silver: Divisional Directors of Operations, Deputy Chief Operating Officer, Onward Care Team Lead, Silver 1 of the day from the site team and a silver representative from each partner organisation.

Gold: Chief Operating Officer at Gloucestershire Hospitals NHS Foundation Trust, and equivalent level role from Gloucestershire Clinical Commissioning Group, Gloucestershire Care Services, 2gether NHS Foundation Trust and Gloucestershire County Council.

The expectations from the Trust during these events are:

  • Meetings to be kept to a minimum.
  • Email traffic will be kept to an absolute minimum. All communication should be face to face or via telephone.
  • Executive led physical presence and support across all wards and departments via Gold command system.
  • Senior manager physical presence and support across all wards and departments via Silver command system.
  • Twice daily board rounds on every ward.

Expectations from system:

  • Greater flexibility to divert to out of hours GP service.
  • CCG intensive support to unblock issues raised by gold command.
  • Full cover from admission prevention schemes.
  • Pro-active community hospitals and nursing home liaison and acceptances.
  • Efficient and timely transport cover and escalation available.
  • Enhanced social services support.

For further information about these events, please contact emergencycare@glos.nhs.uk

Jargon Buster

  • ACU
    Acute Care Unit
  • AEC
    Ambulatory Emergency CARE
  • CCG
    Clinical Commissioning Group
  • ED
    Emergency Department


  • EDD
    Estimated Date of Discharge
  • IDT
    Integrated Discharge Team
  • Pulmonary Embolism
    Pulmonary embolism: A sudden blockage in a lung artery. The blockage is usually caused by a blood clot that travels to the lung from a vein in the leg.


  • SORT
    Sick patients, Out today or tomorrow, Rest of patients, To come in.
  • SPCA
    Single Point Clinical Access
  • TTO (Pharmacy medication)
    To Take Out