Establishing a concierge service to support safe patient flow onsite

Supporting staff to deliver care safely during COVID-19, NHS Grampian worked at pace to establish a patient concierge service as part of their surgical backlog plan. The concierge service helped ensure that those patients requiring time critical surgery could attend the hospital safely. It minimised patient movement and contact within the hospital. Initially the aim was to have the service in place for the month of June (the duration of the backlog project) however due to its success it has continued throughout the pandemic.

Setting up the service involved four key steps which are outlined below.

1) Patient Pathway

Patients were required to self-isolate for 14 days prior to admission and would receive a COVID-19 swab test up to 72 hours before their hospital visit. If negative, the patients would then be advised to attend hospital for their appointment and be met at a designated hospital entrance. Here they would receive a facemask, and temperature and symptom checks would be carried out. Following this, patients would then be escorted to the required ward or to the Department of Scheduled Admissions.

2) Physical Capacity

Picking an appropriate location was essential. It needed to be close to a hospital entrance, easily accessible for patients, yet away from main hospital thoroughfare. Additionally, two waiting areas within a clinic environment were chosen and social distancing procedures were observed. A separate room was also allocated for those who were symptomatic or presented with a temperature.

3) Planning and Coordination

Pivotal to the success of the service was the multi-disciplinary approach that was taken. However, due to the time critical nature of the work, this was limited to key stakeholders. The team liaised with the Medical Secretarial Management Team who offered assistance with practical solutions and advice. A number of protocols were established and documented.

4) Workforce

To minimise the impact of this service on nursing staff, NHS Grampian looked for alternative staffing options. Four members of administration teams from departments which were not running during COVID-19 were redeployed to perform escort duties on a temporary basis. An additional healthcare support worker was required to undertake the temperature and symptom checks. This was funded in part by the surgical division in conjunction with support from healthcare support workers from Pre-operative assessment and Outpatient services.

A total of 325 patients were escorted by the team. Between 3rd and 12th of June, only Urology patients used the service to ensure all required processes and pathways were in place. No patients identified as symptomatic (which would have required them to isolate and their procedure to be cancelled).

Whilst no formal feedback has been sought, conversations with staff have shown that patients were appreciative of the service, and the reassurance it offered them during what was a very anxious time. The fast paced nature of the work, and the fact that there was only one member of bank staff who was involved throughout the month, meant that the focus was on ensuring a robust process was established. This included securing an appropriate location and gaining additional staff.

To overcome initial resistance from clinical staff who were concerned this additional process could produce delays (especially when a patient was first on a theatre list), the team ensured that patients were well informed to arrive ahead of their admission time. They were then promptly escorted to the admission destination as soon as the screening checks were completed.

Additionally, for those administration staff members who had been at home during the pandemic, becoming involved in the running of the concierge service gave them a sense of purpose as they were actively enabling the hospital to maintain patient and staff safety. The bank health care support worker was instrumental in the success of the concierge service, and their dedication to getting the process right for patients was commendable.

The success of the service has meant that it is now run by the Department of Scheduled Admissions and Pre-operative assessment Service as part of the normal admission process for elective surgical patients with a view to it becoming a longer term part of the pathway.

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