Unscheduled Care Winter Workshop
2013/14 Winter Analysis & Preparing for Winter 2014/15
Stirling Management Centre
11 Sept 2014
Unscheduled Care October to March
2011-12 2012-13 2013-14A&E Attendances 795,626 774,655 778,046Performance (%) 95.1 91.9 93.3Waits over 8 hours 3,303 6,574 3,861Waits over 12 hours 551 1,165 403Emergency Inpatient Discharges (acute specialties) 276,317 274,952 280,159
Sources: ISD A&E datamart; ISD SMR01
A&E performance (%) & waits over 12 hoursweekly, Nov to Mar
Source: Weekly management information submitted to Scottish Government
A&E performance (%)
Source: ISD A&E datamart
Delayed DischargesDelayed Discharges over 4 weeks
(including Code 9)Bed Days Lost to Delayed Discharge
Norovirus
Source: HPS
Flu – within normal threshold
Source: HPS
Winter respiratory deaths
TTG – waits over 12 weeks (seen)
Source: ISD Waiting Times Warehouse
Cancer 62 day standard (%)
Source: ISD Cancer Waiting Times Warehouse
Increasing Workforce
Change since last year Change since last year
WTE Dec 2013 n % Mar 2014 n %
Total (excl. GP & GDS) 135,016 2475 1.9 135,626 2,420 1.8
Consultants - All Specialties
4,686 109 2.4 4,770 2,420 3.4
Consultants - Medical Specialties
4,559 114 2.6 4,644 156 3.7
Medical (HCHS) 11,438 141 1.3 11,489 164 2.4
Nursing & Midwifery 57,878 1,269 2.2 58,173 265 2.0
Source: ISD
Preparing for Winter Guidance 2014/15
• Winter planning supports delivery of LUCAPs
• DG H&SC / CEO NHS Scotland Letter to NHS Boards (19 Sept 2014)
• Self-Assessment Checklists (Annex)
Self-assessment checklists
1. Resilience
2. Unscheduled/Elective Care
3. Out of Hours
4. Norovirus
5. Seasonal Flu
6. Respiratory Pathway
7. Mgt Information
8. Sign-off
9. Integration of Key Partners / Services
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
18
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.