Unscheduled Care Winter Workshop

2013/14 Winter Analysis & Preparing for Winter 2014/15

Stirling Management Centre

11 Sept 2014

Unscheduled Care October to March

2011-12 2012-13 2013-14A&E Attendances 795,626 774,655 778,046Performance (%) 95.1 91.9 93.3Waits over 8 hours 3,303 6,574 3,861Waits over 12 hours 551 1,165 403Emergency Inpatient Discharges (acute specialties) 276,317 274,952 280,159

Sources: ISD A&E datamart; ISD SMR01

A&E performance (%) & waits over 12 hoursweekly, Nov to Mar

Source: Weekly management information submitted to Scottish Government

A&E performance (%)

Source: ISD A&E datamart

Delayed DischargesDelayed Discharges over 4 weeks

(including Code 9)Bed Days Lost to Delayed Discharge

Norovirus

Source: HPS

Flu – within normal threshold

Source: HPS

Winter respiratory deaths

TTG – waits over 12 weeks (seen)

Source: ISD Waiting Times Warehouse

Cancer 62 day standard (%)

Source: ISD Cancer Waiting Times Warehouse

Increasing Workforce

Change since last year Change since last year

WTE Dec 2013 n % Mar 2014 n %

Total (excl. GP & GDS) 135,016 2475 1.9 135,626 2,420 1.8

Consultants - All Specialties

4,686 109 2.4 4,770 2,420 3.4

Consultants - Medical Specialties

4,559 114 2.6 4,644 156 3.7

Medical (HCHS) 11,438 141 1.3 11,489 164 2.4

Nursing & Midwifery 57,878 1,269 2.2 58,173 265 2.0

Source: ISD

Preparing for Winter Guidance 2014/15

• Winter planning supports delivery of LUCAPs

• DG H&SC / CEO NHS Scotland Letter to NHS Boards (19 Sept 2014)

• Self-Assessment Checklists (Annex)

Self-assessment checklists

1. Resilience

2. Unscheduled/Elective Care

3. Out of Hours

4. Norovirus

5. Seasonal Flu

6. Respiratory Pathway

7. Mgt Information

8. Sign-off

9. Integration of Key Partners / Services

Festive Key Messages

• 2 x 4 day festive periods (25-28 Dec / 1-4 Jan)• Respiratory & circulatory care • Planned activity & capacity, including social care capacity• Staff rotas over festive periods • Senior clinical decision making capacity – Discharge• Escalation / surge plans (Staffing)• Seasonal flu – staff (50% min) / public vaccination• Business continuity• Staff / public communication plans

Priorities – Now & Winter

1. Emergency (Medical & Surgical) & elective capacity planning & management

2. Whole hospital realignment/re-booting strategy

 

DOWNSTREAM

 

SITE/SECTOR CAPACITY/FLOWBASIC BUILDING BLOCKS

Number of self and 999 attendances

Number of G.P. referrals. Clarify who makes and receives the calls?

ED

Assessment Unit(s) &

What purpose?

RECEIVING 

Or what other

design/flow?

Rehab

Home

Other Flows

Discharge Lounge

Boarding

Number of Direct

Admission planned/

unplanned

Number of Cubicles

Separate and dedicated minors

flow Yes/No

Open24/7 ?

Number of Staff per 100 attendances by grade

Number of Beds

Number of Beds/Cubicles

Discharge/Transfer Average numbers per day/annual to each destination

Number of Staff per 100 attendances, by grade

Number of Beds

Hospital at Home

Integration Plan

LDP

Delayed Discharg

e

3. Engage & empower local clinical & non-clinical teams

4. Professional & managerial leadership around:a. Pre-noon and weekend discharge ratesb. Ward transfer processes

18

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 230

1

2

3

4

5

6

7

8

Transfers in (from ED/AAU) Direct admissions to 'downstream' ward Direct discharges from hospital Transfers out (to ED/AAU)

X: hourly 'downstream' ward admission and discharge profile, 7 Jan to 28 Jul 2013Avg hourly non-ED, non-AAU ward spell* admissions and discharges (excl. all hospital spells that did not involve stays in ED or AAU), n, by hour of daySource: local ED/admitted patient administrative extracts, taken Jul 2013; note: *all non-ED, non-AAU wards treated as a single clinical area to generate 'downstream' ward spells, i.e. results do not show movements between or within 'downstream' wards; transit areas considered out of hospital wrt discharge; results are intended for management information only

Hour of day

Avg

hou

rly 'd

owns

trea

m' w

ard

(spe

ll) a

dmis

sion

s an

d di

scha

rges

, n

5. Recruitment & Retention strategy now for current, February & August gaps – act now (local, regional & national)

6. Delayed Discharge numbers yes, but also bed days lost to Delayed Discharge and patients awaiting care packages in the community.