Governing Body Quality Update Urgent Care and Patient
Governing Body Quality Update Urgent Care and Patient Flow May 2015
Contents • Updated performance and activity information • Trust and system actions to improve quality and performance
Current performance – 95% Standard 95% performance - WRH YTD • 13/14 14/15 15/16 89. 5% 89. 2% 74. 9% Worcestershire Royal Hospital Performance in Apr / May 15 is much worse than in previous years. • Performance in previous years circa 90% YTD in Mid May. This year circa 75%. • Performance shows a similar pattern to the prior year, but at a lower level.
Current performance – 95% Standard 95% performance - WRH YTD • 13/14 14/15 15/16 89. 5% 89. 2% 74. 9% Worcestershire Royal Hospital Performance in Apr / May 15 is much worse than in previous years. 95% performance - ALX YTD • 13/14 14/15 15/16 85. 0% 96. 7% 88. 3% Alexandra Hospital Performance down on last year, but improved on 13/14. • Performance in previous years circa 90% YTD in Mid May. This year circa 75%. • Similar pattern and recovery shown as in 13/14. • Performance shows a similar pattern to the prior year, but at a lower level. • Performance significantly better than WRH.
Emergency Department Attendances Number of A&E Attendances - WRH YTD 13/14 14/15 15/16 8871 9534 8636 Attendances -9. 4% / -2. 6% Number of A&E Attendances – Patients >75 - WRH YTD 13/14 14/15 15/16 1230 1406 1323 Attendances -5. 9% / +7. 9%
Emergency Department Attendances Number of A&E Attendances - WRH Number of A&E Attendances - ALX YTD 13/14 14/15 15/16 8871 9534 8636 YTD 15/16 1230 1406 1323 15/16 7157 7299 7723 Attendances +5. 8% / +7. 9% Number of A&E Attendances – Patients >75 - ALX YTD 14/15 Attendances -9. 4% / -2. 6% Number of A&E Attendances – Patients >75 - WRH 13/14 Attendances -5. 9% / +7. 9% 13/14 14/15 15/16 994 856 1032 Attendances +20. 6% / +3. 8%
Emergency Admissions Number of Admissions - WRH YTD 13/14 14/15 15/16 3856 3875 3500 Admissions -9. 7% / -9. 2% Number of Admissions – Patients >75 - WRH YTD 13/14 14/15 15/16 912 1033 933 Admissions -9. 7% / +2. 3%
Emergency Admissions Number of Admissions - WRH Number of Admissions - ALX YTD 13/14 14/15 15/16 3856 3875 3500 YTD 15/16 912 1033 933 15/16 2492 2520 2320 Admissions -7. 9% / -6. 9% Number of Admissions – Patients >75 - ALX YTD 14/15 Admissions -9. 7% / -9. 2% Number of Admissions – Patients >75 - WRH 13/14 Admissions -9. 7% / +2. 3% 13/14 14/15 15/16 684 642 668 Admissions +4. 0% / -2. 3%
PFC Discharges and DTOCs • Delayed Transfers of Care Changes to reporting methodology in October 14 have made comparisons difficult. • Counting methodology in April 15 now compliant with the requirements of the Care Act. • DTOC - April ‘ 14 = 48, April ‘ 15 = 57. • DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better.
PFC Discharges and DTOCs 121 120 97 91 March 75 Feb 63 37 • 49 48 48 48 51 48 96 59 59 79 63 75 April 57 57 Delayed Transfers of Care Changes to reporting methodology in October 14 have made comparisons difficult. • Counting methodology in April 15 now compliant with the requirements of the Care Act. • DTOC - April ‘ 14 = 48, April ‘ 15 = 57. • DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better. • PFC Discharges (Not shown in chart) PFC discharges account for circa 15% of all acute discharges. • When PFC weekly discharges exceed 100, DTOC figures generally fall. When they are 90 or less DTOCs generally rise. • Improvement plan to get PFC discharges to circa 130 per week.
Trust and System Actions • The SRG has led the development of a system wide urgent care and patient flow plan. • Based on the numerous external reports, internal quality walkthroughs and recognised best practice. • Designed to prevent numerous, fragmented plans. • SRG to take lead in ensuring delivery. • Essential component is the Trust’s Patient Care Improvement Plan (PCIP).
Elements of the plan Three Key Outcomes • Avoiding inappropriate hospital admission. • Treating patients with the best care, in the best place, in the fastest time. • Discharge patients as soon as possible, improving patient flow.
Elements of the plan Seven Key Actions • Seven Day Health and Care services, physical and mental health services, including diagnostics. • Timely and efficient Admission Prevention Services. • Improved access to Urgent Care services with referrals for assessment and not admission. • Best practice urgent care and patient flow within Acute services. • Facilitating effective discharge (including PFC, Pathways 1, 2, 3 and DTOC reduction plan). • Ensure Mental Health support is consistent with national standards. • Winter Resilience Planning.
Elements of the plan • Executive leads for each element of the plan. • Measurable KPIs throughout the plan. • Delivery plans monitored monthly, through Best Practice Urgent Care Committee. • Monthly SRG summary report on key outcomes and actions. • PMO being implemented to support process. • 10 key actions for focus from within plan being agreed to see early improvements.
Challenging outcomes set by SRG • EAS 95% 4 hour target by end of June. • DTOC(delayed transfers of care) reduced to 50 by end of May: – Correct reporting of DTOC figures – Weekly monitoring board – Weekly case management process for complex patients – Escalation to senior leads for “executive action”
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