urgent care improvement board: 4 hour performance november ...€¦ · presentation – a daily...

Urgent Care Improvement Board: 4 Hour Performance November 2014

Executive Summary

Improvement Trajectory

■ The target trajectory is to achieve between 96.5% and 98.3% for Q3. The trajectory

has been refreshed to reflect November 2014 actual performance and all types from

April 2014.

■ Clarification and confirmation of SRG plans in line with the expected trajectory

improvements is required.

■ Key performance measures for the Trust are improving since the introduction of the

Urgent Care Improvement Programme, specifically during the 4 hour step up

improvement period.

Key issues and root causes

■ ED admission rate decreased in month 37.3% (target 37.5%), further analysis required in

December due to change in clinical pathway with MAC direct admissions

■ Ambulance conveyance (+9% in FY14/15)

■ ED is performing well regarding time to treatment performance and patient feedback

■ Majority of 4 hour breaches remain attributable to bed availability

■ BaNES CCG root cause analysis for the weekend period of the 7th to 10th November

■ Impact of the community ORCP schemes to be quantified

Planning

■ The Trust is continuing to run its Urgent Care Improvement Programme

■ The Board initiated a three stage improvement plan

■ Key project for the 2014/15 Programme the development of both Medical and Surgical GP

direct admissions to the Medical and Surgical Assessment Units – operational 12th November.

■ The first stage, the 4 Hour Step Up Programme, focused on actions to be taken by RUH, the

aim to regain performance through September and October. Successfully completed and

reported to the November Board of Directors.

■ This second stage involves a medium term approach to support delivery from November 2014,

including sustaining all urgent care schemes, delivery of GP expected pathways as direct

admissions to both Medicine and Surgery and the delivery of CCG Operational Resilience and

Capacity plans (ORCP). ECIST visit planned 17th December 2014 to review progress,

■ The final stage involves the implementation of a community wide urgent care strategy across

the four CCGs.

■ Performance based upon no greater than 15 DTOC’s in total across all CCG’s.

Current Performance

■ November 4 hour performance was not achieved; 94% (All Types includes Urgent Care

Centre Activity)

■ Weekly green performance achieved since implementation of GP direct admission pathways

(Medical Assessment Unit Area C - MAC)

■ Q3 4 hour performance at risk

Governance and Assurance

■ The RUH Urgent Care Improvement Board is responsible for the programme and

reports monthly to both Management Board and Board of Directors

■ RUH requested from BaNES CCG System Resilience Group an RCA coordinated for

the period 7th – 10th November 2014

■ RUH seeking feedback from the Wiltshire CCG 100 Day Challenge as drawing to a

close

The graph to the right shows

the current trajectory.

RUH 4 hour step up

improvement plan commenced

8th September 2014 and stage 1

completed 31st October 2014.

Key action to continue to

review 4hr performance daily in

Stage 2, linking performance to

ongoing delivery of the Step up

plan operational actions.

Daily monitoring of the

Medically Expected and

Medical and Surgical Direct GP

admission pathways in place.

Ongoing metric review will

confirm that the actions taken

are supporting 4 hour Step up.

Reportable through the Urgent

Care Improvement Board.

Clarification and confirmation

of SRG ORCP plans in line with

the expected trajectory

improvements is required.

Current Trajectory

Week

Ending

Actual

Performance

Standard

06/04/2014 86.0% 95%

13/04/2014 92.7% 95%

20/04/2014 97.7% 95%

27/04/2014 96.8% 95%

04/05/2014 95.4% 95%

11/05/2014 97.1% 95%

18/05/2014 97.0% 95%

25/05/2014 94.9% 95%

01/06/2014 94.6% 95%

08/06/2014 88.1% 95%

15/06/2014 90.2% 95%

22/06/2014 93.5% 95%

29/06/2014 96.1% 95%

06/07/2014 98.0% 95%

13/07/2014 96.7% 95%

Week Ending Actual

Performance

Standard

20/07/2014 94.7% 95%

27/07/2014 94.5% 95%

03/08/2014 96.3% 95%

10/08/2014 92.6% 95%

17/08/2014 89.0% 95%

24/08/2014 90.8% 95%

31/08/2014 87.5% 95%

07/09/2014 91.4% 95%

14/09/2014 94.9% 95%

21/09/2014 95.5% 95%

28/09/2014 96.9% 95%

05/10/2014 96.5% 95%

12/10/2014 90.9% 95%

19/10/2014 87.7% 95%

26/10/2014 95.8% 95%

Week Ending Actual

Performance

Standard

02/11/2014 95.7% 95%

09/11/2014 90.1% 95%

16/11/2014 93.0% 95%

23/11/20014 97.0% 95%

30/11/2014 96.1% 95%

3

DRAFT FOR DISCUSSION PURPOSES ONLY Current Performance

94.0% of patients meeting the 4

hour performance target in

November.

Stage 1 of the Step Up

Improvement completed,

recommendations agreed through

the Urgent Care Improvement

Board and Trust Boards to further

improve performance.

RUH to focus on Medical

Ambulatory Care development

(MAU Area C GP expected

admissions) and Surgical

Ambulatory Care extension of

hours. Services went live 12th

November 2014 delivering 12 of 19

green performance days.

NHS England Type 1 performance

benchmarking RUH ranked 65 of

all NHS Trusts. In November 3

green weeks.

Diagnostic shows a month of two

halves; reduced performance due

to community’s ability to respond

and recovery from the 12th with

direct admission pathway

changes

Remain focused on direct

admission pathways, flow and

back door. No identified

Emergency Department Issues.

The Trust has not consistently met the 4 hour performance target

over the last 2 years, achieving 91.9% in FY12/13, 93.7% in

FY13/14 and is currently 94.2% FY 14/15 year to date.

As a result of this performance the Trust implemented the 2014/15

Urgent Care Improvement Plan which is overseen by the Board.

4 hour performance has been achieved for 2 of the first 8 months of

the year (see table above). The Trust therefore identified the need

for a Step Up Improvement plan to further improve performance.

NHS England benchmarking for November 2014, the RUH ranked

65 of all NHS England Trusts, improved compared to October

2014. Locally the RUH has performed better weekly than all other

trusts except Yeovil who equal 2 green weeks. Overall FY 14/15

year to date 1.6% above NHS England compliance (improved

compared to last month).

Performance below expected national compliance and currently

below RUH trajectory.

2014/15 ED 4 Hour Performance (All Types)

Diagnostic: Compared to trajectory assumptions DTOC and Green

to Go patients increased throughout the first part of the month

contributing to a reduced back door flow and an increase in patients

with a LoS > 14 days. Ambulance conveyance and batching /late

presentation – a daily pattern but significantly exacerbated on the

weekend of Friday 7th November which is under analysis by the

BaNES Urgent Care System Resilience Group; analysis pending

for most providers. RUH reported overall normal weekend activity,

admission to discharge imbalance on the approach to the weekend

reducing the Trusts resilience to respond; early analysis

demonstrates that the community was under pressure with regard

to sufficient capacity and an inability to respond specifically late

afternoon and early evening when HCP ambulance activity is at its

peak. Medical and Surgical pathways changes for GP direct

admissions as per ORCP has had a positive impact on

performance delivering 12 of 19 green performance days. Cycle of

Performance from 12th November improved.

Conclusion: Performance deteriorated in the first half of the month

due to the community's capacity to respond reducing RUH

resilience, which improved significantly from the 12th November

with the introduction of direct admission pathways. Continued

focus on these pathways to further increase performance

opportunity. RCA full outcome required and opportunity to review

providers response to HCP demand later in the day. No identified

issues with ED performance.

Financial Year Quarter Month Attendances 4 Hour Breaches Performance

April 6516 436 93.3%

May 7189 248 96.6%

June 7106 491 93.1%

July 7197 255 96.5%

August 6732 570 91.5%

September 6865 361 94.7%

October 7007 448 93.6%

November 6746 406 94.0%

2014/2015

1

2

3

4

DRAFT FOR DISCUSSION PURPOSES ONLY Impact of Medical Assessment Unit Area C (MAC)

GP direct admissions and Medically

Expected (unless clinically require ED

intervention) directly admitted to MAU

Area C. ECIST recommended pathway.

24 hour 7 day per week service.

Consultant presence; senior decision

makers.

Operational Wednesday 12th November

2014.

First 19 days from operational start .

Aim to manage 20% of the medical take

through Area C – on average in

November 35.% achieved

Daily review of escalation and patient

flow – next steps to review trust wide

escalation policy with specific

reference to both MAU and SAU Area C

Next Steps; increase urgent clinic

availability Cardiology and Neurology

established, and meet with community

for next service development and links

to single point of access

Daily scorecard in place; too early to

draw definitive conclusions; early

indications show the positive effect

this service is having on ED treatment

times at the weekend, post post take

number and same day discharge

therefore a reduction in bed demand.

On the 12th November as per ECIST recommendations Medical

Assessment Unit Area C (MAC) launched; the principle that all GP

direct admissions and medically expected patients (unless clinically

requiring ED intervention) are admitted to MAC. Consequently ED

attendances will be reduced against plan.

From 12th November 2014 Medical Assessment Unit (MAU)

including MAC received 288 direct GP expected admissions

compared to an average of 40 in previous whole months. In

November ED attendances were -250 adverse to internal plan

demonstrating the impact of MAC.

On only two occasions did the % take through MAU Area C fall

below the target 20% for the project. This was at the weekend,

reflecting reduced senior review which has now led to a change in

senior review provision and timing to address senior reviews out of

hours.

20% of patients seen in MAU Area C is the target set to be

discharged the same day; the average for November was 32.1%

exceeding expectations. Only on two occasions did this fall below

20%. See chart.

Urgent clinics are being developed; weekly cardiology and

neurology clinics in place with a plan to extend to Gastroenterology

and Respiratory to facilitate early supportive discharge, in January

2015.

Friends and Family test results will be used as a marker of patient

experience and reported in December.

MAU Area C Activity : Admission and Same Day Discharge Activity

Diagnostic: Length of stay has been reduced on MAU, increased

same day discharge for medically and GP expected patients,

improved ED pathway, improved weekend ED treatment times

which was always elevated in Stage 1 and a reflection of the

pressure at the weekend due to a reduction in discharge; recovery

from Monday onwards and then performance deteriorating into the

weekend when flow is reduced. First three weeks show a change

in cycle and recovery more in line and rhythm with the community –

early indications internal processes improved – best outcome for

patients and contributes positively to 4 hour performance.

Conclusion: Continue to develop the assessment unit philosophy.

Review of Trust escalation plan to support MAU Area C flow to

maintain response and impact on ED.

Overview:

The Trust has created a low and high range target reduction per

week based on their calculation of how many breaches each

scheme will save.

The majority of the reduction in Q3 relates to the Trust’s step up

plan which was planned to take partial effect in October and full

effect from 1st November 2014. The impact of this is a forecast

trajectory of between 97.3% and 99.7% in December 2014.

Improvement Trajectory – 4 Hour Step Up Improvement Plan

The step up plan had three work

streams, front door, flow and

backdoor and twenty immediate

recovery actions were

identified.

Individual plans tracked using

the 4 Hour Step up Daily

Scorecard .

The trust anticipates that the

combined key actions will

reduce the number of breaches

in the Trust through a

combination of front door and

back door improvements.

The low range target is for a

reduction of 49 breaches a week

whilst the stretch target is for a

reduction of 105 breaches per

week.

The analysis shows that the

Trust will need internal and

external plans to deliver at 60-

70% of the stretch target in

order to achieve the 4 hour

standard in January and

February 2015.

Further schemes are anticipated to start to have an impact from

December (Sirona and Somerset CCG). The community ORCP

plans are anticipated to reduce breaches as per the forecast

trajectory.

Further system wide plans are anticipated to take effect in time for

winter. The Trajectory shows that all schemes (excluding the UCC

counting) will need to achieve 60-70% of the stretch target to

maintain performance during January and February.

Forecast Trajectory

Month Low Range Stretch Target

Apr-14 92.7% 92.7%

May-14 96.3% 96.3%

Jun-14 92.4% 92.4%

Jul-14 96.1% 96.1%

Aug-14 90.5% 90.5%

Sep-14 94.3% 94.3% Oct-14 95.2% 96.3%

Nov-14 96.8% 98.7% Dec-14 97.3% 99.7%

Jan-15 94.1% 97.5%

Feb-15 93.7% 96.8%

Mar-15 96.0% 99.5%

Impact on 4 hour wait performance

Month

RUH Sirona Wiltshire Somerset SWAST Dorothy House Primary Care UCC Total

Low High Low High Low High Low High Low High Low High Low High Low High Low High

Oct-14 1.1% 2.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1.1% 2.2%

Nov-14 2.3% 4.4% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.5% 0.2% 2.8% 4.6%

Dec-14 2.2% 4.3% 0.5% 0.9% 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.4% 0.0% 3.1% 5.5%

Jan-15 2.2% 4.3% 0.5% 0.9% 0.6% 1.5% 0.0% 0.2% 0.1% 0.2% 0.0% 0.1% 0.0% 0.1% 0.9% 0.4% 4.3% 7.6%

Feb-15 2.0% 3.9% 0.4% 0.8% 0.6% 1.4% 0.0% 0.2% 0.1% 0.2% 0.0% 0.1% 0.0% 0.1% 0.8% 0.4% 3.9% 7.0%

Mar-15 2.3% 4.4% 0.5% 0.9% 0.6% 1.6% 0.0% 0.2% 0.1% 0.2% 0.0% 0.1% 0.0% 0.1% 0.6% 0.1% 4.1% 7.6%

Appendix 1 November 2014 System Resilience Group Bath and North East Somerset CCG

4 Hour Improvement Trajectory

■ The RUH target trajectory is to achieve between 96.5% and 98.3% for Q3. The

trajectory has been refreshed to reflect November 2014 actual performance and all

types from April 2014.


improvement of between 7 and 14 breaches avoided per week for BaNES CCG

SRG.

Key issues and Root Causes

■ ED attendance has increased by 2.2% compared to 13/14

■ Non-elective ED admissions has increased by 2.6% compared to 13/14

■ Trust wide average numbers of Green to Go total 95 and 165 > 14 days length of stay

■ Trust wide average number of complex discharge daily average 7

■ High level of delayed transfers of care (DTOC) – monthly snapshot 2.4%

Planning


■ The Board initiated an improvement plan to regain performance through September

and October 2014, stage 1 evaluated

■ Medium term approach to support delivery from November 2014 in place, including

care system planning and the delivery of CCG Operational Resilience and Capacity

plans (ORCP)

■ Based upon no greater than 5 DTOC’s

■ Final stage involves the implementation of a community wide urgent care strategy

across the four CCGs supporting 4 hour position

Current Performance

■ November 4 hour performance was not achieved; 94.0% (All Types)

■ Year to date 4 hour performance has been achieved for 2 of the first 8 months

■ CCG contribution to adverse performance (all DTOC and complex patients) equivalent to

13 x 4 hour breaches = 0.17%


■ BaNES CCG System Resilience Group (SRG) KPI monitoring

■ RUH Urgent Care Improvement Board and Management Board

■ Urgent Care Provider Forum Key Projects and overview of progress

Diagnostic Exception Reporting

■ Early analysis of RCA indicates DTOC pressures at the beginning and end of month

Low Stretch

Step down beds x20↑ Discharge 3 3 Investment ORCP/Recruitment/Staffing

Night sitting service

Admission avoidance

↑Discharge

0 1 Recruitment

DN clinics at the weekend

↑ Discharge 0 1 Transport

Discharge at the weekend↑ Discharge 3 4 Investment ORCP/Recruitment/Staffing

IV Therapy↑ Discharge 1 2 Investment ORCP/Recruitment/Staffing

SWASFT Mobile rapid response/fallers Admission avoidance 0 1Investment ORCP/Recruitment/Staffing

Dorothy House Hospice at Home↑ Discharge

0 1Investment ORCP

Primary Care Extra GP Sessions

ED Attendance Avoidance

Admission avoidance 0 1

Investment ORCP/Recruitment/Staffing

Sirona

Scheme Potential Benefit Per Week Breach

Avoidance

Risks to Delivery

Appendix 2 November 2014 System Resilience Group Wiltshire CCG






improvement of between 9 and 22 breaches avoided per week for Wiltshire CCG

SRG.



■ Non-elective ED admission increased by 3.9% compared to 13/14

■ Trust wide average numbers of green to go total 96 and 165 > 14 days length of stay

■ Trust wide average daily number of complex discharges total 16

■ High level of delayed transfers of care (DTOC) – monthly snapshot 5.4%

Planning




■ Medium term approach to support delivery from November 2014, including care system

planning and the delivery of CCG Operational Resilience and Capacity plans (ORCP)




Current Performance



■ CCG contribution to adverse performance (all DTOC and complex patients) equivalent

to 59 x 4 hour breaches = 0.85%


■ Wiltshire CCG System Resilience Group (SRG) KPI monitoring



■ RUH seeking feedback from 100 Day Challenge as drawing to a close

■ Early analysis of RCA indicates DTOC pressures at the beginning of the month,

continued from October

Low Stretch

Community Escalation CapaictyAdmission avoidance

?Discharge

1 3 Staff capacity

Overnight community support Admission avoidance 0 0 Recruitment

GWH community cluster teams Admission avoidance 1 3 Recruitment

Healthcare professional l ine Admission avoidance 0 0 None

Help to live at home brokerageAdmission avoidance

?Discharge

1 2 Care Home Capaicty

Step up and step down capacity ?Discharge 5 7 New model not tested

Simple point of access and rapid

response

Admission avoidance

?Discharge

1 3 None

Additional POC ? Discharge 0 1 Care Home Capaicty

Domicill iary Care Support ? Discharge 0 1 Staff capacity

Additional Hospital Social Care

Capacity

? Discharge 0 1 Staff capacity

Primary Care Nursing Home

Initiative Admission avoidance0 1 Primary Care Capacity

Wiltshire


Avoidance

Risks to Delivery

Appendix 3 November 2014 System Resilience Group Somerset CCG






improvement of between 1 and 5 breaches avoided per week.



■ Non-elective ED admission increased by 7.4% compared to 13/14

■ Trust wide average numbers of Green to Go total 95 and 165> 14 days length of stay

■ High level of delayed transfers of care (DTOC) 4.6% monthly snapshot

Planning




■ Medium term approach to support delivery from November 2014, including care system

planning and the delivery of CCG Operational Resilience and Capacity plans (ORCP)




Current Performance



■ CCG contribution to adverse performance (all DTOC and complex patients) equivalent

to 4 x 4 hour breaches = 0.4%


■ Somerset CCG System Resilience Group (SRG) KPI monitoring



■ Early analysis indicates DTOC pressures increasing towards the end of the month

Low Stretch

Enchanced out of Hospital Care Admission avoidance 0 1 None

Home Care Packages ?Discharge 0 1 None

Crisis Support Night Sitting Admission avoidance 0 1 Recruitment

GP Weekend Response Admission avoidance 1 2 GP Capacity

Mental Health Admission avoidance 0 0 Recruitment

Somerset

SWASFT


Avoidance

Risks to Delivery

Appendix 4 RUH Operational Resilience and Capacity Summary of Assurance November 2014

RUH Key Performance Indicators


■ Non-emergency patient transport

Planning

■ The Trust is continuing to run its Urgent Care Improvement

Programme

■ The Board initiated an improvement plan to regain 4 hour

performance through September and October 2014. Stage 1

completed and reported.

■ Medium term approach to support delivery from November 2014,

including care system planning and the delivery of CCG

Operational Resilience and Capacity plans (ORCP)

■ Final stage involves the implementation of a community wide urgent

care strategy across the four CCGs

Current Performance

■ All RUH schemes on plan



■ BaNES and Wiltshire CCG formal contract review of NPTS (Arriva) due 1st

December 2014

■ KPI’s for all community ORCP schemes required to determine impact upon

4 hour trajectory

Core ORCP Funding - Summary of plan to achieve requirement

Provider

Estimated

Costs in

2014/15

BaNES

Agreed

ORCP

Funding

(41.3%)

Wiltshire

Agreed

ORCP

Funding

(44.3%)

Somerset

Agreed

ORCP

Funding

(14.4%)

KPI Oct-14 Nov-14 Comments

95% 4 Hour Performance

(all types) 93.6% 94.0%

Step up improvement plan in place as part of RUH

Urgent Care programme including SRG

contributions to performance

Total Trust Wide Beds Open

(monthly daily average).

Plan to open 22

9 6 Monthly average escalation beds open

Increased radiology capacity CT/MRI/US to support ED, MAU,

SAU, ESAC and Medical Ambulatory Care.

£389,870 £161,016 £173,000 £0

% CT/MRI inpatient

requests completed in 24

hours (target 80%)

85.6% 87.9%CT/MRI scans completed within 24 hours of

request (inpatient)

Scheme A: Weekend discharge registrar (10am to 6pm

Saturday and Sunday).

Scheme B: Acute Oncology. Increase the service to 7 days per

week -

Scheme A: Evening ward rounds Medical Assessment Unit.

Scheme B: Increasing Medical Ambulatory Care Capacity until

8pm Monday to Friday (Medical Assessment Unit Area C -

MAC)

Weekend and Evening

Consultant MAU Ward

Rounds (target average 7

patient reviews per round)

N/A 14 November 2014 start

% of Medical direct

admissions to MAU Area C

discharged on the same

day. Target 20%

N/A 32.10% November 2014 start

4 Hour Performance (all

types) Target 95%93.6% 94.0%

Step up improvement plan in place as part of

Urgent Care programme

Total Trust Wide Beds Open

(month average). Plan to

open 10

N/A N/ACapital works commenced on plan. Beds due to

open 15th December 2014

Additional non-emergency patient transport to support

patient flow during periods of high discharges and if discharge

needs to be less than the 4 hour NSL and Arriva contracted

response times. Piloted in 2013/14 programme and very

successful with x2 crews. Plan to use x1 crew 11:00-20:00 day

seven days per week which will be managed by the RUH

transport lead who will maximise activity.

£49,500 £20,444 £0 £0 4 per day 32 40

Additional capacity to support discharge.

Subject to ongoing audit (led by RUH transport

Lead with BaNES CCG)

Number of Discharge

reviews reported via the

Discharge Registrar (target

24)

28 47November 2014 start as per ORCP; October start

in line with identified operational requirement

Flexible non-elective medical bed capacity. 12 beds have

been identified to be used during periods of escalation and 10

beds overnight

£1,191,051 £491,904 £264,000 £100,000

£43,913 £18,136 £19,000 £0

£102,124 £42,177 £45,000 £0

£97,000 £0£219,623 £90,704

Additional capacity on core specialty wards to support flexible

capacity modeling. Detailed bed modeling has been

completed by the RUH BIU team, in addition to demand

predictions (based upon 5 year averages) supporting flexible

capacity during periods of highest demand. 4 beds to open

mid December 2014 and a further 6 by the end of December.

10

DRAFT FOR DISCUSSION PURPOSES ONLY Appendix 5 November 2014 RUH Urgent Care Improvement Programme

Overall assessment of the Urgent Care

Programme in November is AMBER.

Front Door. Medical ambulatory care activity

decreased in month, direct impact of MAC

from 12th November 2014. Median wait to

treatment target sustained and improving.

Continued focus on Medical Ambulatory Care

development (MAU Area C GP expected

admissions) and Surgical Ambulatory Care

extension of hours.

Introduction of MAC has lowered the post

post take ward round number to below target

(i.e. reduced MAU length of stay)

Flow. Increased adult bed occupancy,

increased medical outliers. All markers of the

trust in escalation, increased ED admission

rate and increased acuity. All seen at the start

of the month.

Backdoor. Adult non-elective LoS in line with

target. Non-elective geriatric LoS average

and non-elective discharges from ACE-OPU

recovered.

Overall decrease in bed days lost due to

DTOC and complex discharges.

Remain focused on Flow and Back Door as no

identified Emergency Department Issues.

ECIST visit planned for the 17th December

2015 – MAC/SAU and Trauma Pathway review.

The Trust has not consistently met the 4 hour performance target in

2014/15. Diagnostic: Diagnostic: Compared to trajectory

assumptions DTOC and Green to Go patients increasing

throughout the first part of the month contributing to a reduced back

door flow and an increase in patients with a LoS > 14 days.

Ambulance conveyance and batching /late presentation – a daily

pattern but significantly exacerbated on the weekend of Friday 7th

November which is under analysis by the BaNES Urgent Care

System Resilience Group; analysis pending for most providers.

RUH reported overall normal weekend activity, admission to

discharge imbalance on the approach to the weekend reducing the

Trusts resilience to respond; early analysis demonstrates that the

community was under pressure with regard to sufficient capacity

and an inability to respond specifically late afternoon and early

evening when HCP ambulance activity is at its peak. Medical and

Surgical pathways changes for medically expected and GP direct

admission as per ORCP has had a positive impact on performance

delivering 12 of 19 green performance days.

Conclusion: Continued focus on Flow and Backdoor actions and

improvement as per the step up improvement evaluation

recommendations to the Board of directors in November. ECIST

team to review the GP direct admission services on the 17th

December 2014.

.

2014/15 Urgent Care Programme Trust Metrics

Key Actions;

1) From the 12th November 2014 direct pathway to the Medical

Assessment Unit (MAU) Area C for GP expected patients. GP

referred patients, unless clinically an emergency no longer.

assessed in the Emergency Department. Aim to assess one third

of the medical take through MAC. KPI monitoring through UCIB

refer to page 4.

2) SAU Area C now operational 7am to 7pm Monday to Friday.

Further work required to collect robust metric data and determine

% surgical take through the ESAC service. KPI monitoring through

UCIB.

3) 4 hour step up improvement scorecard integrating MAC and ESAC

performance measures in place.

4) RUH ORCP scheme implementation and KPI monitoring in place

5) Wiltshire CCG ED attendance audit and anticipatory care planning

to support ED attendance avoidance.

6) Integrated Transfer Team implementation.

7) ECIST recommendation implementation.

8) Focus on “sustain” work streams.

9) Four Hour Step Up Improvement recommendations and actions to

implement

urgent care improvement board: 4 hour performance november ...€¦ · presentation – a daily...

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