Unscheduled Care

Learning Event

Issues Identified from

Winter Planning Review

Michael Bloomfield

19 March 2015

2014/15 Activity and Performance Data

Apr – Feb (13/14): 634,287 Apr – Feb (14/15): 647,128 Variance: 12,814 % Variance: 2.0%

Apr – Feb (13/14): 178,260 Apr – Feb (14/15): 184,024 Variance: 5,764 % Variance: 3.2%

Apr – Feb (13/14): 126,691 Apr – Feb (14/15): 128,830 Variance: 1,690 % Variance: 1.3%

Apr – Feb (13/14): 78.4% Apr – Feb (14/15): 77.9% Variance: -0.5%

Apr – Feb (13/14): 2,701 Apr – Feb (14/15): 2,561 Variance: -140 % Variance: -5.2%

Apr – Feb (13/14): 16,974 Apr – Feb (14/15) : 16,847 Variance: -120 % Variance: -0.7%

Apr – Feb (13/14): 2,574 Apr – Feb (14/15) : 3,511 Variance: 937 % Variance: 36.4%

January – February 2015 vs 2014

Activity and Performance

28/12/13-07/03/14 : 127,826 27/12/14-06/03/15 : 131,021 Variance: 3,195 % Variance: 2.5%

28/12/13-07/03/14 : 39,062 27/12/14-06/03/15 : 40,522 Variance: 1,460 % Variance: 3.7%

28/12/13-07/03/14 : 27,363 27/12/14-06/03/15 : 28,216 Variance: 853 % Variance: 3.1%

28/12/13-07/03/14 : 75% 27/12/14-06/03/15 : 73% % Variance: -2.1%

28/12/13-07/03/14 : 563 27/12/14-06/03/15 : 1,195 Variance: 632 % Variance: 112.3%

28/12/13-07/03/14 : 3,464 27/12/14-06/03/15 : 4,287 Variance: 823 % Variance: 23.8%

28/12/13-07/03/14 : 718 27/12/14-06/03/15 : 960 Variance: 242 % Variance: 33.7%

Acuity Indicators

Jan – Feb 2015 Jan – Feb 2014 Variance

ED attendances aged 80+

8,534 7,747 + 787 (10%)

Triage Categories 2 + 3

60,055 56,243 + 3,812 (6.7%)

Emerging Learning from Review of Winter 2014/15

Winter Planning

• Earlier planning for winter, including confirmation of additional funding

• Greater understanding of the whole system based on robust data, not anecdote

• Elective activity profiled to maximise bed and staff capacity over winter period

• Schedule training and associated activities over 9/10 month period

• Match staffing levels to times of increased demand• Additional ENP staffing levels to maintain minors flow

Community Preparedness

• Timely response to increase in demand, including at holiday periods

• ‘What good looks like’ for community services

• Greater understanding of capacity needed for complex discharges at key periods

• Development of ‘discharge to assess’

Escalation

• Include whole system, not just in hospital• Develop clear early warning triggers across the whole

system to prompt early action• Need reliable, real time information to inform decision

making• Importance of senior leadership of escalation meetings• Importance of visibility of senior clinicians in ED during

times of high demand/increased pressure• Provision of dedicated ambulance discharge capacity• De-escalate early

System/Pathway Issues

• Understand the value of further development of Hospital Diversion Teams, Rapid Response Services, Physician of the Week, Discharge to Assess

• Further development of seven day services, including senior reviews

• Improve repatriation of patients between Trusts