Stirling Management Centre11th September 2014

Unscheduled Care National Event

Learning Workshop

Festive Key Messages

• 2 x 4 day festive periods (25-28 Dec / 1-4 Jan)• Respiratory & circulatory care • Planned activity & capacity, including social care capacity• Staff rotas over festive periods • Senior clinical decision making capacity – Discharge• Escalation / surge plans (Staffing)• Seasonal flu – staff (50% min) / public vaccination• Business continuity• Staff / public communication plans

Priorities – Now & Winter

1. Emergency (Medical & Surgical) & elective capacity planning & management

2. Whole hospital realignment/re-booting strategy

 

DOWNSTREAM

 

SITE/SECTOR CAPACITY/FLOWBASIC BUILDING BLOCKS

Number of self and 999 attendances

Number of G.P. referrals. Clarify who makes and receives the calls?

ED

Assessment Unit(s) &

What purpose?

RECEIVING 

Or what other

design/flow?

Rehab

Home

Other Flows

Discharge Lounge

Boarding

Number of Direct

Admission planned/

unplanned

Number of Cubicles

Separate and dedicated minors

flow Yes/No

Open24/7 ?

Number of Staff per 100 attendances by grade

Number of Beds

Number of Beds/Cubicles

Discharge/Transfer Average numbers per day/annual to each destination

Number of Staff per 100 attendances, by grade

Number of Beds

Hospital at Home

Integration Plan

LDP

Delayed Discharg

e

3. Engage & empower local clinical & non-clinical teams

4. Professional & managerial leadership around:a. Pre-noon and weekend discharge ratesb. Ward transfer processes

6

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 230

1

2

3

4

5

6

7

8

Transfers in (from ED/AAU) Direct admissions to 'downstream' ward Direct discharges from hospital Transfers out (to ED/AAU)

X: hourly 'downstream' ward admission and discharge profile, 7 Jan to 28 Jul 2013Avg hourly non-ED, non-AAU ward spell* admissions and discharges (excl. all hospital spells that did not involve stays in ED or AAU), n, by hour of daySource: local ED/admitted patient administrative extracts, taken Jul 2013; note: *all non-ED, non-AAU wards treated as a single clinical area to generate 'downstream' ward spells, i.e. results do not show movements between or within 'downstream' wards; transit areas considered out of hospital wrt discharge; results are intended for management information only

Hour of day

Avg

hou

rly 'd

owns

trea

m' w

ard

(spe

ll) a

dmis

sion

s an

d di

scha

rges

, n

5. Recruitment & Retention strategy now for current, February & August gaps – act now (local, regional & national)

6. Delayed Discharge numbers yes, but also bed days lost to Delayed Discharge and patients awaiting care packages in the community.

GP in & OOH’s Services,

Social Care, NHS 24, SAS, ED,

GP Sub-specialisation

95% TargetHospital

Assessment, treatment,

& admission Joint

anticipatory care ,

frailty models

Site elective & Emergency Demand & Capacity Planning Internal FlowIn Patient Discharge Planning

Effective Integrated Chronic

Disease and Discharge

Management

Alternatives to attendance and

admission Digital health

Appropriately Avoiding long

term care.

Rehabilitation Community Hospitals

Care at Home

Delivery of sustainable Unscheduled Care Performance: A Whole System Target

Acute Care

Community

Primary Care

Sir Muir Gray’s presentation on community based specialty care.

Hospital

“A Place of Safety”

Primary Care

• Alternatives to Admission• “Direct” admission• Anticipatory Care• Hospital at Home

Hospital Specialists

Sector/Practice Teams

(Sub Specialisation and Primary/Community Care Consultants?)

Community Based Health Care

Shared Goals and Teams

Key National Groups

UC Steering Group

Primary Care Strategic Forum

7 Day Task Force

Vision

New Teams

Role Development

Senior Decision Support Model

Clinician/Team Match

Condition/Presentation by time of day