Rachana vyas-presentation-(urgent-care)-final


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Rachana vyas-presentation-(urgent-care)-final

  1. 1. LLR Urgent & Emergency Care Improvement Plan Rachna Vyas, Cluster Unscheduled Care Lead 29th September 2011
  2. 2. Governance <ul><li>LLR Emergency Care Network (ECN) set up Jan 2011 </li></ul><ul><li>Senior Executive membership, both managerial & clinical with clear links to each Clinical Commissioning Group </li></ul><ul><li>Multi-agency plan with timescales & leads </li></ul><ul><li>Weekly performance dashboard </li></ul><ul><li>Other stakeholders bought in as required </li></ul>Local Authorities LPT GEH EMAS UHL Clinical Comm. Groups PCT ECN
  3. 3. Key multi-agency challenges tackled through the ECN <ul><li>Management of attendance levels to ED/Bed Bureau </li></ul><ul><li>Management of Mental Health Patients in ED </li></ul><ul><li>EMAS Patient Transport Service; Service delivery & cancellations </li></ul><ul><li>Tackling delayed discharges </li></ul><ul><li>Robust winter planning </li></ul><ul><li>Systems design </li></ul><ul><li>Delivering reablement services </li></ul><ul><li>Pathways for Frail Older People </li></ul><ul><li>Improving Discharge processes </li></ul><ul><li>UHL internal processes & workforce development </li></ul><ul><li>Creating a LLR Single Point of Access </li></ul>
  4. 4. Challenge 1: Rising demand on acute services affects service delivery in the ED <ul><li>Actions: </li></ul><ul><li>Cluster-led streaming project initiated in June 2010 to reduce the number of patients treated in the ED by up to 10% (at additional cost). </li></ul><ul><li>Every GP practice across LLR monitored weekly against an agreed target to reduce usage of acute care, inc. both ED attendances and admissions. </li></ul><ul><li>Targeted communications/social marketing work launched in certain areas of Leicester City showing highest inappropriate use of ED. </li></ul><ul><li>Progress: LLR current position is -1.4% against planned activity </li></ul>
  5. 5. Challenge 2: The response to ED by the Crisis Response Team causes delays in the patient journey <ul><li>Actions: </li></ul><ul><li>1. LPT undergoing a full review of the acute adult mental health pathway </li></ul><ul><li>2. Enhancing the Adult Liaison Psychiatry Service to: </li></ul><ul><ul><li>Increase out of hours liaison psychiatry presence within ED in UHL between 5pm – 12pm seven days a week </li></ul></ul><ul><ul><li>Provide dedicated Mental Health expertise at point of admission </li></ul></ul><ul><ul><li>Reduce waiting times </li></ul></ul><ul><ul><li>Provide improved care pathway for the acute medical units (15 & 16) and short stay units (33) </li></ul></ul><ul><ul><li>Divert patients from ED to the Urgent Care Centre where they can be assessed in a more appropriate environment </li></ul></ul><ul><ul><li>Improve the transfer of patients requiring crisis intervention or admission to LPT </li></ul></ul><ul><ul><li>Support the redesign of Acute Mental Health Care Pathway </li></ul></ul><ul><li>Progress: </li></ul><ul><li>The enhanced service is due to go live in Oct 2011 </li></ul>
  6. 6. Challenge 3a: The ‘re-bedding’ of patients causes unnecessary delays in the patient journey <ul><li>Actions: </li></ul><ul><li>Re-specify Patient Transport Service contract to provide a fit-for-purpose service within the current financial envelope </li></ul><ul><li>Increase communication channels between UHL-EMAS </li></ul><ul><li>PTS crews will be made available earlier to transport those patients who are made ready before midday </li></ul><ul><li>Earlier escalation to UHL to ensure that mitigating actions can be enabled if delays arise </li></ul><ul><li>Re-issue PTS Eligibility criteria to city and county General Practices, as well as all UHL wards. </li></ul>Progress: Average number of rebeds per week for 11/12 has been 9. 10/11 Q3/4 average was 12 per week.
  7. 7. Challenge 3b: Late cancellations of PTS services reduces availability of crews and interrupts service delivery <ul><li>Actions: </li></ul><ul><li>Root cause analysis of cancellations by reason </li></ul><ul><li>Targeted multi agency teams tackling specific issues </li></ul><ul><li>Progress: </li></ul><ul><li>The number of ambulance cancellations has dropped across all categories, taking the total number of cancellations to over half of that in Jan 2011 </li></ul>
  8. 8. Challenge 4: Multi factorial delays in discharging medically fit patients block beds – reportable & non reportable delays <ul><li>Actions & progress: </li></ul><ul><li>In talks with community equipment provider to reduce waits for community equipment to less than 24hrs where possible, esp. in periods of surge </li></ul><ul><li>Discharge planning principles discussed earlier are also being applied to community provision to ensure patient flow is not disturbed due to delayed/late discharges </li></ul><ul><li>Work continues with nursing and residential homes to improve quality of care at points of admission and to ensure timely discharge </li></ul><ul><li>LPT undergoing an acute pathway review, with a view to ensuring that delayed discharges due to access to beds are minimal for patients transferring to LPT inpatient beds </li></ul><ul><li>Review of bed capacity agreed across LLR. Toby Sanders is the SRO </li></ul>
  9. 9. Challenge 5: Winter planning needs to be both innovative and meticulous to ensure a robust urgent care system through winter 11/12 <ul><li>Actions: </li></ul><ul><li>Specific holiday period service availability planner prepared across primary care, secondary care & social care </li></ul><ul><li>Agreed escalation & de-escalation process agreed across all LLR agencies </li></ul><ul><li>Joint multi-agency public signposting & communication </li></ul><ul><li>Weekly communications from Sept 1st to the Health Protection Agency re Flu </li></ul><ul><li>Director to Director contact for any closure/stop </li></ul><ul><li>Multi agency ‘Plan B’ being drafted – what do we need to do over and above what we have already prepared? </li></ul><ul><li>Progress: </li></ul><ul><li>LLR Escalation plan re-engineered with full stakeholder support following comments from IMAS and learning from winter 10/11 </li></ul><ul><li>‘ Plan B’ options being modelled ready for winter 11/12 </li></ul>
  10. 10. Challenge 6 – Application of ‘Systems thinking’ to ensure that we work across agencies to deliver an innovative and tailored system of care for LLR <ul><li>Actions & progress: </li></ul><ul><li>The Urgent care pathway across LLR is currently being modelled in conjunction with the CCG’s & UHL, but will be geared towards multi agency partnership working to deliver an integrated, safe and consistent service. </li></ul><ul><li>Key deliverables across the pathway: </li></ul><ul><ul><li>Integration of Urgent Care Centre and ED “front door” </li></ul></ul><ul><ul><li>Redesign of Loughborough walk in centre, with more medical cover made available </li></ul></ul><ul><ul><li>Review of the Minor Injury provision across Leicestershire County </li></ul></ul><ul><ul><li>Increased capacity in the Emergency Department </li></ul></ul>
  11. 11. Challenge 7: Promoting independence and reducing demand through reablement Action: Collaborative proposals drawn up and currently going through governance processes Summary of proposals for each area below: <ul><li>Leicester City </li></ul><ul><li>Coordinated Community Reablement/RIT teams </li></ul><ul><li>Additional 10 Intermediate Care Beds in 11/12 </li></ul><ul><li>Help at Home, Handy Person and Assistive Technology Service </li></ul><ul><li>Development of City Single Point of Access </li></ul><ul><li>Enhanced Hospital Team </li></ul><ul><li>Community Coordinators/Demand Managers 12/13 </li></ul><ul><li>Leicestershire County </li></ul><ul><li>Resourcing of IC teams </li></ul><ul><li>Resourcing of social care reablement teams </li></ul><ul><li>Development of Single Point of Access </li></ul><ul><li>Hospital at home scheme </li></ul><ul><li>Rutland County </li></ul><ul><li>On-going development of an integrated reablement & intermediate care service </li></ul>
  12. 12. Challenge 8: Implementing pathways for Frail Older People to deliver a coordinated and high quality service <ul><li>Progress: </li></ul><ul><li>Emergency Frailty Unit </li></ul><ul><li>May-Jul 2010 vs. May-Jul 2011 </li></ul><ul><ul><li>Number aged 85+ attending ED has increased by 10% (relative increase) </li></ul></ul><ul><ul><li>Overall discharge rate from ED for people aged 85+ has increased by 20% (relative increase) </li></ul></ul><ul><ul><li>90 day readmission rates have halved from 26% to 14% </li></ul></ul>Action: Frail Older People service implemented with the aim achieving a 20% reduction in admissions to base wards for those patients referred to the service.
  13. 13. Challenge 9: Improving UHL Discharge processes to facilitate patient flow through the system <ul><li>Action: </li></ul><ul><li>‘ Estimated Date of Discharge’ set and adhered to </li></ul><ul><li>‘ To Take Out’ medicine & pharmacy mobilised </li></ul><ul><li>Coordination with EMAS Patient Transport Service </li></ul><ul><li>Earlier discharge from LPT community beds </li></ul><ul><li>Targets & Progress: </li></ul><ul><li>Discharges by 1pm – Q1 targets achieved at both UHL and community sites </li></ul><ul><li>Plans for continual improvement in place to ensure targets are met for the year. </li></ul>
  14. 14. Challenge 10a: Improving ED Processes to offer a streamlined and efficient pathway through the Emergency Department <ul><li>Actions & Progress: </li></ul><ul><ul><li>Transfer of Neurology services from Leicester General to Leicester Royal site </li></ul></ul><ul><ul><li>Closure of Emergency Medical Unit on LGH site </li></ul></ul><ul><ul><li>Emergency Frailty Unit (EFU) established </li></ul></ul><ul><ul><li>Introduction of Bed Bureau Triage in both Medicine & Surgery (33% admission avoidance) </li></ul></ul><ul><ul><li>Ambulatory Pathways being implemented </li></ul></ul><ul><ul><li>‘ See, Treat And Triage’ team introduced - senior decision maker supported by qualified nurse and Health Care Assistant. In place from 10.00am to 12 midnight daily - commenced in June 2011 </li></ul></ul>
  15. 15. Challenge 10b: Development & mobilisation of a UHL workforce development strategy <ul><li>Action: </li></ul><ul><li>Development of a workforce development plan in conjunction with the East Midlands Deanery & external guidance </li></ul><ul><li>Progress: </li></ul><ul><li>Appointments made to date: </li></ul><ul><ul><li>Substantive Consultants x 2 </li></ul></ul><ul><ul><li>Locum Consultant posts x 2 </li></ul></ul><ul><ul><li>Enhanced consultant cover 20.00hrs to 01.00hrs </li></ul></ul><ul><ul><li>Advanced Practitioners (AP) 5/6 </li></ul></ul><ul><ul><li>Physicians Assistants (PA) 3/5 </li></ul></ul><ul><ul><li>Health Care Assistants 2 x 18 – accelerated training to band 3 in 6/12 </li></ul></ul><ul><ul><li>GP recruitment x 5 (flexible with Urgent Care Centre) </li></ul></ul><ul><ul><li>Speciality Doctor x 1 </li></ul></ul><ul><ul><li>Geriatrician/Physician support to the Emergency Department in place </li></ul></ul><ul><ul><li>Designated consultant of the week to cover Emergency Decisions Unit established </li></ul></ul>
  16. 16. Challenge 11: Integrate the current 11 ‘single points of access’ across health and social care to enable 1 single point of access across LLR <ul><li>Actions & progress: </li></ul><ul><li>Multi agency plans are being drawn up to agree a single overarching plan, detailing a phased approach to integration of the various projects across LLR, including those in the reablement proposals. </li></ul><ul><li>NHS 111 pilots are currently running across Nottingham City and Lincolnshire, with plans for the rest of the region to pilot the service in April 2012. </li></ul><ul><li>Discussions are underway across agencies to provide to a safe and effective pilot for the LLR region with each CCG. </li></ul>Health SPA Regional piloting of the NHS 111 project Leics County LA SPA Leics City LA SPA
  17. 17. Critical issues to address in the next few months: <ul><li>Designing a robust ED-UCC interface and ensuring that other urgent care provision across LLR is aligned to form an integrated service </li></ul><ul><li>Efficient patient flows out of ED into rest of hospital </li></ul><ul><li>Out of hours service delivery across providers to reduce inappropriate admissions </li></ul><ul><li>Single point for admissions into UHL </li></ul><ul><li>Single Point of Access/111/bed bureau delivery model </li></ul>
  18. 18. Thank you for your time. Please feel free to ask any questions.