Rotherham NHS Foundation Trust
A real-time view of hospital operations, so the right people can act before situations escalate.
Rotherham NHS Foundation Trust is an NHS organisation delivering a broad range of acute and specialist services across the Rotherham area.
A hospital manages hundreds of variables simultaneously. Bed availability, A&E wait times, staffing levels, ambulance turnaround, treatment duration. Each of these is tracked somewhere. But knowing how they combine, and what the combined picture means for the organisation right now, is a different problem entirely.
The Problem
NHS hospitals do not lack data. They lack a coherent, real-time view of what that data means.
Individual departments track their own metrics. Systems log their own events. But translating those numbers into a single operational picture, one that tells the right people how the hospital is performing and whether it needs to shift into a higher gear, requires something that many trusts simply do not have.
The cost of not having it is slow response. When a situation escalates gradually across multiple departments, it can reach critical before anyone has a clear picture of what is happening across the organisation as a whole.
The Challenge
Data coming from many sources, in many formats
Rotherham NHS Foundation Trust receives operational data from a range of systems, including FHIR-compliant clinical data servers, web hooks and manual data entry. Each source has its own format, frequency and structure. The escalation management system needed to ingest all of them and translate them into a consistent picture.
Thresholds that vary across metrics and departments
Not all metrics work the same way. For bed availability, a higher number is better. For wait times, a higher number is worse. Some indicators are quantitative, some qualitative. The system needed to handle all of these correctly, with configurable thresholds for each, and aggregate them meaningfully into an organisational-level status.
A layered criticality model that reflects how hospitals actually work
Hospitals do not operate on a binary "everything fine / everything critical" basis. They need to know when things are starting to deteriorate, before they hit a crisis point. The system needed to support four levels of operational status: green, amber, red and critical, each with different implications for how staff and departments should respond.
Notifications that mobilise the right people at the right time
Knowing the organisation has hit a critical level is only useful if the right people find out and know what to do about it. The system needed to notify the correct teams when thresholds were crossed, with different contact groups for different severity levels and different operating hours, and the ability to manually declare an emergency when the situation demanded it.
The Solution
The Escalation Management System, EMS, is a real-time operational monitoring platform for Rotherham NHS Foundation Trust. At its centre is a tiered status model: a visual dashboard showing the trust's current operational status across four criticality levels, updated continuously as new data comes in.
Data flows into EMS from multiple sources on intervals as short as one minute. Each data point is mapped to a metric, evaluated against configurable thresholds, and contributes to a layered hierarchy of indicators, from individual measurements up to department-level status and, ultimately, to the organisation's overall operational level.
When the status changes, EMS notifies the right people. Notification groups are fully configurable, with separate contact lists for different escalation levels, in-hours and out-of-hours rules, and the ability to trigger scheduled summaries alongside event-driven alerts. Clinicians and department heads can also manually declare a level four emergency when the situation on the ground requires it, regardless of what the system metrics show.
EMS is live and in active use at Rotherham NHS Foundation Trust.
Our Approach
Building a configurable data ingestion layer
EMS needed to handle operational data from fundamentally different sources: structured clinical data coming through FHIR servers, event-driven web hooks and manual form submissions. The Curve built a configurable ingestion layer that allows administrators to define new data sources and map incoming values to metrics without requiring code changes, giving the trust flexibility to extend EMS as its data infrastructure evolves.
Designing the threshold and aggregation model
The system supports both ascending thresholds, where a higher value is better, and descending ones, where a higher value indicates a problem, as well as qualitative levels where values are defined descriptively rather than numerically. Metrics roll up through a weighted hierarchy into department-level indicators and then into the organisation-level status, recalculating continuously as new data arrives.
Making criticality visible and actionable
The dashboard gives trust leadership and department heads a live view of operational status at every level of the hierarchy. When the status changes, configured notification groups are triggered automatically. The manual override capability for level four declarations ensures that clinical judgment can always take precedence over system metrics when circumstances require it.
Keeping a critical system running
EMS is not a reporting tool that gets consulted occasionally. It is a live operational system that the trust depends on. The Curve provides ongoing maintenance and support, including security updates, dependency management and monitoring, ensuring the platform remains reliable as the environment around it changes.
The Results
A real-time operational picture, updated by the minute: Data from across the trust flows into EMS on intervals as short as one minute. Leadership and department heads have a live, consolidated view of how the organisation is performing at any given moment, rather than relying on reports or manual updates.
Faster escalation and response: When operational status changes, EMS notifies the right people immediately, through the channels they are monitoring. A level four event triggers a different response from a level two. Heads of department know when to shift their teams into a higher gear without waiting for information to travel up the chain manually.
A flexible, extensible platform: The configuration model means the trust can add new data sources, adjust thresholds and update notification groups without requiring development work. EMS adapts as the trust's operational needs change, rather than locking the organisation into a fixed set of metrics.
A hospital at level four is not the same organisation it was at level one. The protocols change, the priorities change, the way people work changes. What does not change is the need for everyone to know, quickly and clearly, that it has happened. EMS gives Rotherham NHS Foundation Trust the situational awareness to act before a situation becomes a crisis, and the communication infrastructure to mobilise when one does.