Are you

Red2Green

Ready?

Red2Green

Watch ECIP RED and Green days video here

“The purpose of the Red and Green bed days is to highlight

what a patient might be waiting for on the journey through

the hospital from the point of admission through to the

point of discharge”

it is not a reporting instrument, it is a

tool to help clinical teams to progress

patient care to ensure they minimise

unnecessary waiting, for such things as

decisions and diagnostics, the team

progress and escalate if any

unnecessary waiting

The template for doing Red and Green

in each hospital will be subtly different;

you can’t transplant a red and green

bed day process from one hospital to

another

Red2Green

By reducing the amount of ‘wait & harm’ (Red days) throughout a patients journey, it is possible to reduce overall LOS and risk of harm

without changing the clinical care received by the patient

Care &

Wait &

Care &

Care &

Care &

Care &

Wait &

Wait &

Wait &

Wait &

Wait &

Day 1 Day 2 Day 3 Day 5 Day 4 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11

Red to Green is used at the daily board round to assist in the identification of wasted time in a patient’s journey

Care &

Care &

Care &

Care &

Care &

Day 1 Day 2 Day 3 Day 4 Day 5

Why can’t I go

home today?

STH RED2GREEN Pilot

In March 2018, teams from 3 ward areas across 2 different directorates worked together to design and

implement a Red2Green pilot for Sheffield Teaching Hospitals. The aim of the pilot was to evaluate the

benefits and challenges of using the Red2Green principles.

The wards that were involved are Robert Hadfield 2, Robert Hadfield 5 and Brearley 2.

Members of the MDT from each area, including Consultants, Ward Clerks, Nurses, Therapists and Transfer

of Care Nurses came together, supported by members of the Organisational Development Team,

Technology Transformation Team and Information Services Team.

Together, the teams designed the Red2Green process and flow chart and decided which technological

changes would support the pilot on the eWhiteboard and the data set that they would find useful.

The pilot took place between the 16th and 27th April, where the teams put the principles, the flow chart, the

eWhiteboard changes and the daily check in into action. Each day, the Organisational development team

attended each pilot ward area to support the implementation and to gather finer details of the data and

learning about the process.

An evaluation meeting took place at the end of the pilot and although very early to have enough data to

prove success, the 3 wards decided to continue to use Red2Green and gather more data over time. The

general feeling was that Red2Green is a positive way to identify internal issues, which could be explored as

part of ward improvement work. The teams are planning to meet again after a month of using the

Red2Green tool for further analysis.

For further information please contact:

Stacie Harrington/Sarah Gascoigne (Ward Sisters Robert Hadfield 2) Stacie.Harrington@sth.nhs.uk

Sarah.Gascoigne@sth.nhs.uk

James Kapur (Consultant Geriatrician Robert Hadfield 5) James.Kapur@sth.nhs.uk

Lindsey Swain (Ward Clerk Brearley 2) Lindsey.Swain@sth.nhs.uk

Kerry Pickering, Shona Simmons, Michelle Carroll (Organisational Development) Kerry.pickering@sth.nhs.uk

Shona.simmons@sth.nhs.uk, Michelle.carroll@sth.nhs.uk

Benefits

Challenges

STH RED2GREEN Pilot Staff Feedback

Better Communication

Check in prevents jobs

being missed

Check-in allows TOC nurses to

know what’s happening with patients

if they couldn’t get to Board Round

Check in keeps the

whiteboard up to date

Board Round is more

focused and decisions

are made

Helps identify

improvement

opportunities

Is encouraging when patients

are turned green at check in

Is a way to be listened to- gives

the data to prove the points

Resistance to change

Senior Medics need to be involved from the

beginning

Culture issues: is red blame

or improvement opportunity?

Check ins shouldn’t be long

like a Board Round- should be

a couple of questions to

check the task has been done

How to keep track of the jobs from the morning

Midnight all patients switch to

Red

Board Round review all patients

Is the patient waiting for something TODAY that is necessary to progress

their care?No

Green

RED

Internal: Choose discharge delay

category –1. NOT DTOC

2. From drop down menu choose delay

reason

External: Choose reason from

discharge delay category - (Care

package, offsite bed etc.)

Check in point1. Check outstanding actions from

morning board round.2. Update whiteboard with current red/

green status

Yes

Red2Green Flow Chart

Why Not Home?

Why Not Today?

Why Not Home?

Why Not Today?

Does the Care need to

be delivered in an acute setting?

Does the Care need to

be delivered in an acute setting?

Remember to capture ALL actions that need to happen for the day in the clinical/nursing

handover. Ensure that the most significant internal/external reason is selected from the

drop down list

Remember to capture ALL actions that need to happen for the day in the clinical/nursing

handover. Ensure that the most significant internal/external reason is selected from the

drop down list

Remember: continue to complete any further actions as they arise to prevent our

patients from waiting unnecessarily

Remember: continue to complete any further actions as they arise to prevent our

patients from waiting unnecessarily

Select NOT DTOC category here Select Red/Green status here

Select reason for NOT DTOC here

Documenting Red/Green - Whiteboard View

Not Delayed Transfer of Care (Not DTOC)

See Speciality review guidance for further information on Speciality review

Not Delayed Transfer of Care (Not DTOC) reasons

Not Delayed Transfer of Care (Not DTOC)

Delayed Transfer of Care (DTOC)

Documenting Red/Green – Web View

Care Group

Clinical Directorate Speciality

Combined Community and Acute (CCA)

Integrated Geriatric & Stroke Medicine

Care Of The Elderly Stroke Medicine

Therapeutics and Palliative Care Palliative Medicine Dietetics

Emergency Care(EC)

Accident and Emergency Accident and Emergency General Medicine

Head & Neck services ( H&N)

ENT

Audiological Medicine Ear, Nose and Throat

Neurosciences

Neurology Neurosurgery Rehabilitation Stereotactic Radiosurgery Transient Ischaemic Attack

Ophthalmology

Medical Ophthalmology Ocular Oncology Ophthalmology Paediatric Ophthalmology Vitreoretinal Surgery

Speciality Review Guidance

Oral and Dental

Maxillo-Facial Surgery Oral Surgery Paediatric Dentistry

Laboratories, Engineering, Gynaecology, Imaging, Obstetrics, Neonatology ( LEGION)

Obstetrics, Gynaecology and Neonatology

Gynaecology Gynaecology Oncology Midwife Episode Neonatology Obstetrics Paediatrics Well babies

Medicine & Pharmacy Services (MAPS)

Diabetes and Endocrinology

Diabetes Endocrinology

Gastroenterology

Bowel Screening Gastroenterology Hepatology

Respiratory Medicine

Adult Cystic Fibrosis Chest Medicine Pulmonary Vascular Disease

Care Group

Clinical Directorate Speciality

Musculoskeletal (MSK)

Musculoskeletal

Metabolic Bone Orthopaedic Orthopaedic Fracture Osteoporosis Pain Management Podiatric Surgery Rheumatology Spinal Surgery Service

South Yorkshire Regional services (SYRS)

Cardiac Services

Cardiac Surgery Cardiology Cardiothoracic Surgery Thoracic Surgery

Renal Services

Nephrology Renal Transplant

Vascular Services

Vascular Radiology Vascular Surgery

Anti-coagulation

Speciality Review Guidance

Specialised Cancer, Medicine & Rehabilitation (SCMR)

Communicable Diseases and Specialised Medicine

Clinical Immunology Dermatology Genito-Urinary Medicine Haematology Infectious Diseases Specialist Rehabilitation Service Oncology Radiotherapy

Spinal Injuries and Rehabilitation

Spinal Injuries

Surgical Services (SS)

General Surgery

Colorectal Surgery General Surgery Hepatobiliary & Pancreatic Surgery Obesity Surgery Upper Gastrointestinal Surgery

Plastic Surgery

Breast Surgery Burns Plastic Surgery

Urology

Urology

Check-In

Have the actions agreed at the morning board round

been completed?Yes

Green

Patient stays RED

Check-inReview Red patients

No

Why ot ome, Why ot oday

oes the care need to be delivered in

an acute se ng

What needs to happen today that is

necessary to progress pa ent care

Red2Green Check-in Flow Chart

The data collected on the eWhiteboard from Red2Green is displayed on the SAFER

Tasks need to be recorded in

the morning and then

checked in the afternoon.

DATA

Daily check at an

agreed time

bespoke to the ward

MDT attendance bespoke

to the ward

Needs to be led/facilitated

ideally by someone who has

attended the morning board

round

If key members of the board round

cannot attend the check-in they

must ensure that they have updated

the whiteboard with update e.g.

therapy completed

Remember to

continue to complete

any further actions as

they arise

Needs to be structured

focused and timely

Why Not Home?

Why Not Today?

dashboard.

This dashboard can be filtered by dates and by ward. It sometimes takes a while for the data to be displayed, this is because of the number of pieces of information the dashboard is pulling together.

There is a function available when clicking onto the Red/Green graph, which displays the list of patients making up the graph and the last recorded Red reason of the day. This is useful for identifying the same delay over a number of days.

Data can be used by the ward areas to feed into Improvement forums, ward meetings, or other opportunities where the cause of the red reasons can be discussed. Teams can then use the data to develop change ideas aimed at improving the red reasons.

SAFER Data dashboard link ( click to access the dashboard)

SAFER dashboard Screen shots

Example –SAFER DASHBOARD for Ward RH5

Select date range here

Select Ward here

(Multiple wards can be

selected)

Select

weekends/weekdays/

both here

To view description of data hover mouse over the title - To view actual numbers hover mouse over the

graph

Numbers of discharges are shown

according to the time of day the

patient was discharged on Lorenzo

By clicking on the

Red/Green days graph, it

is possible to identify the

list of patients and the

last Red reason of the day

1. My patient is waiting for multiple things. What do I do?

Record all of the actions that the patient is waiting for in the Clinical plan or Care note section of

the whiteboard and use the drop down box to record the action which will have the most impact

on the progress of the patient care. At the check in if all of the actions are completed, the

patient can turn green, if there are still any outstanding, the patients stays red and the reason

from the drop down box needs to be changed to reflect the reason having the most impact on

the progression of the patient care.

2. My Patient is medically fit and is waiting for a care package to start and also need TTOs and

transport what do I record?

If a patient is medically fit and are waiting for care packages such as D2A, 5Q ( DTOC delay) but

they also need TTOs and transport, the latter can only be captured in free text on the clinical

plan or care note section of the whiteboard. The DTOC delay must be captured in the drop down

box in the delay category.

3. My patient was waiting for something this morning that has now been done. But at the check

in they are now waiting for something else. Are they red or green?

This patient is now green, as the task(s) that they were originally red for has been completed.

This does not mean that completing further actions should stop. The new actions should still be

updated in the clinical plan or care note section of the whiteboard with and aim to complete

them. This is an opportunity to complete actions to prevent the patient waiting further and

before they are picked up as a delay at the following morning board round.

4. My patient has just arrived on the ward and not yet been seen by a doctor. What do I record

them as?

If your patient has arrived with a clear plan in place, they are green.

If the plan for your patient isn’t clear, and you won’t know whether or not they are waiting for

something until they have been reviewed by a doctor, they are red. Use the reason ‘New patient

not yet reviewed’ or ’Awaiting senior review’, whichever is the most appropriate for the patient.

5. My patient is waiting to go home. Are they red or green?

If everything has been done for the patient, and they are just waiting to leave, then they are

green. If they are waiting for an ambulance to collect them to take them home, then they are

red until they are collected.

6. My patient is red because they are waiting for a diagnostic test e.g. X-ray when does this turn

green?

This should only be turned green once the patient has had the diagnostic test, this has been

reviewed and a plan is in place to progress the patient care

Q & A

7. My patient needs an ECHO at some point during their inpatient stay. Does that make them

red?

The echo should be requested as soon as there is a need identified. This will stay red until the

echo has been performed and a plan is in place to progress the patient care

8. My patient needs daily blood tests throughout their inpatient stay. Does this mean they are

red every day?

If blood tests are needed as regular monitoring and management and are not delaying progress

they are green.

9. My patient is not medically fit and is on a course of IV antibiotics lasting 5 days and needs a

chest X-ray today. Is this patient red or green as they are still receiving their antibiotics?

If the patient needs the X-ray today, they will remain red until the X-ray has been completed,

reviewed and a plan is in place for further progress.

10. My patient is receiving Oxygen therapy and is waiting to get better is this red or green?

If plan is in place for a patient and they are receiving ongoing active treatment and just waiting

to get better, the patient will be green unless they need any further tests or actions. By receiving

active treatment, the patient’s care is being progressed, and there is value of the patient being

in hospital.

11. How can I find the data from my ward?

Data for your ward can be found on this Dashboard link here. Data can be used to understand

what patients are frequently waiting for and feed into improvement meetings where change

ideas can be tested in order to make improvements and reduce patients waiting time.