Anne Marie MarleyRespiratory Nurse Consultant BHSCT

Dr Stephen TateRespiratory Physician SET

Achieve consensus on respiratory patient flow issues across NI

Identify immediate high impact changes to implement improvement

Identify capacity/resource issues What additional support is required to effect

change Try and get some data

Wide consultation-email, meetings, Regional workshop

ICP leads, clinicians, MDT, managers

Perceived problems-Unnecessary admission, process for senior decision making, could more patients be managed in community, more ambulatory care, better inpatient flow, improved discharge planning

Task and finish work-COPD Bundles, ambulatory pathways for PE and pleural effusion

Further develop Respiratory MDT to include 7 day working and extended hours

Improve sharing of information across systems-NIECR Targeted reviews and risk stratification Develop a ‘champion’ to lead and co-ordinate service

development including utilisation of voluntary sector Direct access to respiratory team/decision maker More accessibility to IV antibiotics (DN teams) Training for NH staff on exacerbation man/end of life Develop regional criteria, consistent guidelines for

community teams to reduce variation

Develop ambulatory pathways between ED/AMU/Respiratory teams

Develop physician of the week, small MD team to manage ‘take in’ and liaise with GP’s –impact on rotas and elective work

Reduce size of MAU’s to support redistribution of speciality bed base-consider high dependency patients for safe out of hours take in

Review clinical, MDT and bed capacity to ensure it can meet admission volume (support to ED, twice daily take in rounds, regular pull from MAU, discharge planning)

Consider direct admission arrangements-link to HUB/Community teams/GP’s

Develop respiratory assessment unit for rapid assessment Consider breathlessness service with cardiology/COE Improved joint working with Older people’s services-Negotiate

handover process for frail elderly Improved coding of disease presentation to support service

planning and commissioning

All sites to implement ambulatory pathways (PE and unilateral pleural effusion)

Implement COPD discharge care bundle (RSF) Review capacity, prioritising community for

rapid assessment and admission avoidance (RSF)

Develop direct take for chronic respiratory disease patients-longer term action

Hasten implementation of the NIECR and extend notation to all clinicians