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) [email protected]
James Kapur (Consultant Geriatrician Robert Hadfield 5) [email protected]
Lindsey Swain (Ward Clerk Brearley 2) [email protected]
Kerry Pickering, Shona Simmons, Michelle Carroll (Organisational Development) [email protected]
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.