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


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