Patient flow, ambulance handovers - The Northumbria – Winter resilience

• Level of care system and separation of acute / elective• Emergency department – speciality ward – discharge home, or transfer

to base site or transfer to community hospital• Separate, commissioned decant transport

• Emergency care consultants working 24/7 – providing senior cover and support

• Consultant working seven days, 12 hours a day for all specialty wards / ward areas – eight in total, all admission units, nil else

• Acute medicine consultant presence till midnight• Pharmacy and other support services - seven day working• Diagnostic services seven days a week, 12 hours a day• Ambulatory care and surgical assessment unit• Critical care• Some elective, high risk surgery• Planned for 200 attends (mostly majors)

The Northumbria model

• Increase in demand from public Like the rest of the NHS we have seen a huge increase in attendances in urgent and emergency care - overall as a trust we had an 18% increase if you look at the data in the year immediately before opening the Northumbria and the year afterwards:

• June 2014 – May 2015 – 141,672 attendances trustwide• June 2015 – May 2016 – 166,717 attendances trustwide= 18% increase (over 25,000 more people accessing urgent and emergency care services)

Urgent and emergency care usage

• Reduction in emergency hospital admissions Despite the huge increase in urgent and emergency attendances during 2015/16, since centralising specialist emergency care onto one site at The Northumbria, we have has recorded an average of a 14% reduction in emergency admissions to hospital - against a national context of increasing emergency hospital admissions

Between June 2015 and April 2016, 7,496 less people have been admitted to hospital and equates to a saving for the whole local health economy of over £6 million for 2015/16

Urgent and emergency care usage

We have cut admissions

Emergency admissionsThe Northumbria, North Tyneside, Wansbeck and Hexham general hospitals

We turned even more around from within the emergency department…

Ratio: A&E attends to emergency admits

…and initially reduced long stay patients (>14 days)

Long stays: Patients staying longer than 14 days

77% of all admissions (>16) go home from The Northumbria

Average length of stay = 1.9 days

Sustained A&E performance

September 2016 England position = 90.6%

• We run one of the largest and most comprehensive patient experience programmes in the NHS as well as a widely-publicised ‘We’re listening’ feedback channel to capture the views of patients, staff and members of the public

• Since The Northumbria opened, over 3,700 patients have given their feedback about their care on the wards with 98% likely or highly likely to recommend their care to friends and family

• In the emergency department, 9 out of 10 patients would rate their care as good, very good or excellent

Patient experience

• Significant change to the working pathways of all partner urgent care organisations (in the context of a significant increase in demand) and this has had unintended as well as intended consequences

• We are committed to our own continuous improvement to do what we can (Flo)• We and partner organisations recognise that whilst each organisation has a part

to play no single organisation can fix it on its own. We are committed to working with partners in the urgent care system to fix ambulance handover issues. The dip in A&E performance and ambulance handover has complex causes that include multiple factors that affect flow and it will take time for the system to adjust

• We are committed to learning from others and are active partners in Urgent Care Network, NHS Improvement Urgent Care Collaborative and actions arising from Emergency Care Improvement Programme (ECIP) visit

…of the new model of care

The Northumbria is now the region’s largest receiving emergency department with over 3,500 ambulance arrivals every month and more than 100 crews arriving every single day – more than any other north east hospital

• Ambulance handovers difficult to achieve• flow out of emergency department• triage personnel• volumes

• Shifting of work into evening and night

Recent work to improve the flow of patients is starting to have a noticeable impact in reducing queues and the time taken to handover care

Hospital challenges

Ambulance arrivals at The Northumbria

NEAS ambulance handovers

NEAS ambulance handovers

• Provision of direct access for paramedics to Medical Ambulatory Care and Surgical Assessment Unit - a dedicated telephone number for ambulance service to allow access to services

• Updated Directory of Service so ambulance service can take the patients where appropriate to the urgent care centres rather than The Northumbria

• Allocated dedicated waiting space to allow handover of patients • Contract with ERS has been extended to provide a service for care of the

elderly patients• Initial positive feedback following recent ECIP visit around tackling the

issues of ambulance handover

Actions – The Northumbria

• Plan in place setting out our approach to managing the challenges of increased demand and/or reduced capacity by proactively reviewing, improving and implementing operational resilience and capacity measures to minimise the impact on patient care during winter

• Plan focuses on ongoing and robust capacity planning for year round operational resilience

Organisational resilience and capacity plan - winter 2016/17

• Prevention and protection - staff flu vaccination campaign, links with community to avoid unnecessary admissions

• Preparation and planning - strategies for increasing capacity in all business units, and supporting organisations e.g. local authority and Northumberland, Tyne & Wear (NTW)

• Response and recovery – Trigger points, command and control arrangements

The plan includes

• Risks are identified within the plan e.g. bed capacity, outbreaks, staff absence

• To provide assurance risk treatments have been identified e.g. escalation plans, business continuity and capacity strategies at all levels (Department/ Business Unit/Trust)

Risks

The plan contains detailed escalation information on:

• Trust NEEP (Escalation Plan) – NEEP linked to regional NEEP levels

• Community Services (inc Northumberland Social Care)• Emergency Surgery and Elective Care• Emergency Care and Medicine• Children’s Services• Maternity

Escalation plans

• Daily reporting (weekend activity reported on a Monday) is submitted by Unify2 on the Trust’s status e.g. bed status, any infection control issues, attendance numbers etc.

• A regional daily conference call to NECS at midday is undertaken by all Trusts to give the Trust’s picture.

• Templates within the winter plan (NEEP) facilitate this information

• 2 December 2016 NEEP will become OPEL – operational pressures escalation plan

Winter reporting

Any questions?