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Acute Service Management
Liz MooreDirector of Acute Services
NHS Ayrshire & Arran
Background
• Decide to Admit – 2009 • Constrained Facilities – assess/admit through Emergency
Departments
• Business Cases – Building for Better Care – 2009/10
• Emergency Care Quality Improvement Programme – 2011
New DevelopmentsBusiness Case – 2012 / 2013
University Hospital AyrEmergency Department
Construction commences – September 2014Construction Complete – December 2015
Combined Assessment Unit
Construction commences – December 2015Construction Complete – March 2017
• 29 En-suite Rooms• Assessment Bays• Ambulatory Areas
University Hospital CrosshouseCombined Assessment Unit
Construction commences – October 2014Construction Complete – March 2016
• 35 En-suite Rooms• Assessment Bays• Ambulatory Areas
Management StructureDirectors
Unscheduled Care / Planned Care / Care of the Elderly Community Services
Managers
Speciality specific across sites
2 Acute Hospitals·
Ayr – 350 Beds· Crosshouse – 650 Beds
Community Hospitals·
Ayrshire Central Hospital· East
Ayrshire Community Hospital·
Kirklandside Hospital·
Girvan Community Hospital · Arran War Memorial Hospital· Lady Margaret Millport
Management Structure
• Acute Services Director – University Hospital AyrUniversity Hospital Crosshouse
• Health & Social Care Partnership developments
• Restructured – Hospital Specific Management (Ayr/Crosshouse)
• Emergency Care Quality Improvement Programme/LUCAP
Whiteboards
Continuous Assessment
Community Wards
GP AA’s
CDUs
ACPs
Frail Elderly Pathway
Site Management
Hospital Huddles
Weekend Discharge
Morning Discharge
Safer Patient Developments
• New structure – Safety Focus/Hospital Team Focus
• Get to really know site/people. Help change happen
• Service issues every day / weekend / overnight
• Job Roles – 7 day working
• Assistant Director of Acute Services for each site
• Hospital Huddle – January 2014
• Thanks to Lynn – Edinburgh Royal Infirmary
• 30+ staff attended walk/talk through
• Associate Medical Director and SPSP Fellow
• Set Date – Hospital Huddles/7 day working – June 2014
Safer Patient Developments
Launched TogetherHuddle / 7 Day Working
• Huddle Chaired by Assistant Directors
• 8am on both sites: 30 – 50 staff attend
• Safety: Scripts – Focused informationSafety Issues/Patient FlowAnticipate activity of day/respond
• Visible Commitment of Team/Managers/Collective Responsibility for hospital
• University Hospital Ayr – 12 Staff: – Assistant Directors– GMs– AGMs– CNMs
• University Hospital Crosshouse – 16 Staff: – Assistant Director– GMs– AGMs– CNMs
• Weekday shift 12noon – 8pm: Overnight on-call
• Weekend shifts (same manager): Friday 12noon – 8pm Saturday 8am – 4pm
Sunday 8am – 4pm Remainder of weekend -On-call
Extended Days/7 Day Working
Feedback StructuresWhat do our Managers say?
7 Day Working• Hard to do jobs
when no others working weekends
• Emails pouring in over weekdays when on days off
Weekend SupportLess calls late at night/weekends
Huddles Brilliant!
• Hospital has become closer/more sharing of everything!
• Hard to imagine not having them
• Taken Team work to next level
Gained insight into pressures
across whole system
Visible Proactive
Leadership
Immediate practical support valued
Less weekday meeting time
Manager presence valued by
staff
Performance visibly improved
Outcomes
• Rapid response to adverse events/support staff
• Reduction in Out of Hours activity which should have been completed in-hours/tea time patient flow blocks
• Improves patient flow and performance against 4 hour standard
• Enhanced multi-disciplinary working
• Morning discharge?
• Weekend discharge?
NHS Ayrshire & Arran A&E 4 hour performance
January 2013 to August 2014
Jan 2013
Feb 2013
Mar 2013
Apr 2013
May 2013
Jun 2013
Jul 2013
Aug 2013
Sep 2013
Oct 2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
Mar 2014
Apr 2014
May 2014
Jun 2014
Jul 2014
Aug 2014
75%
80%
85%
90%
95%
100%
NHS A&A 95%
UH Crosshouse and UH Ayr A&E 4 hour performance
January 2013 to August 2014
Jan 2013
Feb 2013
Mar 2013
Apr 2013
May 2013
Jun 2013
Jul 2013
Aug 2013
Sep 2013
Oct 2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
Mar 2014
Apr 2014
May 2014
Jun 2014
Jul 2014
Aug 2014
75%
80%
85%
90%
95%
100%
UH Ayr UH Crosshouse 95%
Question
How do we really deliver patient discharge before 12noon?