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 and orthopaedic teams in order to build on previous local work and improve the patient experience of flow between emergency and specific specialist teams.
How they did it?
Project governance teams were formed at each site as well as working groups. The intention was to implement five phases of EBCD. All sites carried out phase 1 (planning and startup) however there was considerable variation between sites in implementing phases 2-5. All sites used staff and patient interviews and video. Interviews with external stakeholders, observations, tag alongs, patient and staff surveys and diagnostic workshops were used variably across the seven sites. All sites conducted co-design workshops and all sites developed implementation plans based on priority areas identified in the co-design phase. Despite difference in implementation all sites reported similar challenges and achieved similar outcomes.
What was the impact?
Follow up after 24 months in program 1 sites (stage 2) indicated all sites had sustained and extended improvements. Specifically, evaluation of the follow-up programme reinforced the earlier finding that EBCD:
taught project staff new skills
enabled frontline staff to appreciate better the impact of health-care practices and environments on patients and carers
enabled frontline staff to appreciate better the impact of health-care practices and environments on patients and carers;
engaged consumers in ‘deliberative’ processes that were qualitatively different from conventional consultation and feedback
achieved practical solutions that realize the wishes, advice and insights of consumers and frontline staff.
 Evaluations indicated participants felt that EBCD work had improved operational efficiency and interpersonal dynamics in their units. Staff and patients reported a deepened understanding of each other’s experiences. EBCD appeared to produce change that mattered to patients which in turn raised clinician morale. Practical changes were made in all seven sites. Areas of change included: improving patient and carer comfort and privacy; improving physical space for staff and patients; and improving communication between staff and between staff, patients and carers.
 EBCD activities were viewed as an additional burden by staff. Lack of dedicated time may have reduced the impact and sustainability of the programs.
Project staff reported a need for increased support and reporting opportunities. Project staff reported patient recruitment was sometimes extremely difficult in the ED setting. There was high turnover of patients between the diagnostic and solution co-design phase perhaps indicative of the transient relationship of patients with EDs. Recruiting a small number of patients required a very large

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