(Analyst Workshop 19) Karen Morrow
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This document discusses using data to inform unscheduled care. It describes developing a new dashboard to provide real-time data to duty managers for managing capacity and demand across three acute hospital sites. The discovery period involved reviewing existing information and identifying additional available data. Key stakeholders collaborated to design the new dashboard, testing different visualizations and filters to ensure only relevant data was included. The new dashboard provides eight days of historical data and live updates on emergency department demand, capacity, wait times, and breaches to help duty managers make decisions.
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Consultant Connect is a service that connects NHS Tayside consultants with professionals to provide advice and avoid unnecessary admissions. It allows secure recording and review of calls. Since launching in October 2018, it has facilitated over 12,000 calls between emergency medicine consultants, GPs, and the Scottish Ambulance Service, with 30% of ambulance calls avoiding ED attendance. Feedback from GPs has been positive, praising the quick access to specialists and improved patient care. There is potential to expand the service to additional specialties.
SAS Managing Admission Volume : Jim Ward
This document discusses managing admission volume for the Scottish Ambulance Service. It shows that over time, the percentage of unscheduled cases managed by telephone or face-to-face assessment has increased from 28% to 38%. The non-conveyance rate for ambulance incidents handled by the Integration Joint Boards has also increased from 0% to nearly 50% from 2018-2019. Interventions like governance processes, clinical guidelines, and professional support have helped with this. Data is also presented on response rates varying between most and least deprived areas, top reasons for calls, and opportunities to further reduce conveyance rates through expanded community support services for patients.
Midlothian Intermediate Care : Sharlotte Patterson
Midlothian Intermediate Care provides assessment, equipment, and rehabilitation services to minimize hospital time and maximize independence for Midlothian residents aged 18+ who are medically ready for discharge. They have supported 185 patients, saving an estimated 1360 bed days and £419,863.10 by addressing needs like mobility, toileting, and unfinished assessments through multidisciplinary teams including occupational therapy, orthopedics, and stroke specialists.
Integration : Brian Slater
Integration is about more than just technical and bureaucratic changes - it requires a new approach to planning services with a shared vision and shift in culture. Additional funding alone will not solve challenges facing the NHS, fundamental reform is needed to deliver care in a new way. Intermediate care services are designed to prevent hospital admission or facilitate faster discharge through a coordinated, holistic approach providing time-limited support to maintain independence at home.
Mental Health : Jacques Kerr
This document discusses mental health (MH) related unscheduled care attendances in Scotland from 2014/15 to 2018/19. It notes that the proportion and numbers of emergency department (ED) attendances related to MH issues have been increasing each year. People with MH presentations are more likely to live in deprived areas and be conveyed by ambulance or police. They are also twice as likely to breach the 4 hour waiting time standard in ED compared to other patients. The document proposes several actions to improve the MH unscheduled care pathway such as developing distress intervention groups for collaborative multi-agency crisis response and linking unscheduled and MH care leads to analyze local data and service use.
Attendances : Helen Maitland
Rising unscheduled care attendances are putting pressure on A&E departments across Scotland. Attendances have increased by 63,750 (4.8%) over the past two years, with the largest rises in NHS Highland, Greater Glasgow and Clyde, Fife, and Lanarkshire. Self-referrals have risen the most, increasing by 3.6%. Younger age groups like 0-4 have seen higher attendance increases. Several initiatives are underway to better manage demand, including improved redirection of non-emergency cases, social media campaigns on alternative care options, and consultant-led triage of referrals.
Pointilist : Helen Maitland
The document discusses pointillist charts that visualize patient flow and length of stay data for emergency departments. It describes the current charts, which are based on local Scottish data, and plans to produce standardized charts using national Irish health data. The charts cover metrics like length of stay by arrival time, flow group, and breach reason. There are aims to expand the charts to include additional breakdowns of the data and integrate them into a system for monitoring hospital performance.
System Watch : Fiona MacKenzie
System Watch is an information resource developed by ISD Scotland to inform planning of emergency and urgent care across NHS services in Scotland. It predicts emergency admissions and bed days, monitors trends in demand, and is updated daily/weekly. It provides data on admissions, NHS 24 calls, Scottish Ambulance Service incidents, A&E attendances, GP consultations, deaths, and delayed discharges. Health Boards will use System Watch to develop demand and capacity projections to inform their winter planning assumptions. The document outlines what data is available in System Watch and how to access it.
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The document discusses using data to improve emergency department operations. It summarizes how collecting data on doctor time spent per patient and total ED work can help identify areas for improvement. Taking 10 extra minutes to properly assess a patient could result in a 2-3% improvement in meeting the 4-hour target. Heat maps showing patient volumes over time helped staffing profiles be adjusted and the medical assessment unit hours extended during peak times. Staff found visualizing the data in this way helped them better understand issues and plan targeted improvements to help patients flow through the ED system more efficiently.
Scotland : Derek Bell
The document contains data and charts about emergency department (ED) performance and attendance in Scotland. It includes information on:
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DoC - Brian Slater presentation
This document discusses reducing hospital usage through better collaboration between acute and community care. It highlights that delayed discharges often occur because patients are flagged as medically fit before truly being ready, and that hospitals sometimes try to shift responsibility for delays. Successful initiatives seen include strong leadership, multi-disciplinary discharge hubs involving social work and other supports, and home-first approaches. Reflections note that achieving change requires focusing on outcomes over process, changing behaviors, and allowing time for changes to take effect.
DoC - Helen Maitland presentation
The document discusses using Day-of-Care Surveys (DoCS) to improve patient flow across acute and community hospitals in Scotland. It provides an overview of recent Pan-Scotland DoCS results, including that 21% of patients surveyed did not meet criteria for ongoing acute care. It recommends developing integrated health and social care action plans to address the top reasons for discharge delays. The document also provides recommendations for using DoCS data to prioritize reducing lengths of stay and shifting the discharge time curve earlier.
(Analyst Workshop 19) Kirstin McNicol & Kathy McGregor
This document discusses developments to national unscheduled care analysis tools in Scotland. It provides an overview of System Watch, which monitors trends in emergency and urgent care across NHS services, and predcits emergency admissions. Recent and upcoming enhancements to System Watch are outlined, including the addition of year-on-year trends data and enhanced syndromic surveillance. The document also describes the Take 10 tool for analyzing emergency department performance and reducing variation in patient journey times. Pointillist charts for visualizing length of stay data from selected sites are discussed. Feedback on the analysis tools is welcomed.
(Analyst Workshop 19) Robert Williams
Systemwatch has implemented a new platform to cover unscheduled care data after lunch each day. The UC Programme Board is exploring ways to exclude elective procedures from re-admission denominator calculations. An A&E Datamart and Pointillist pilot aims to move weekly unscheduled care data submission to ISD. The Unscheduled Care Collaborative now includes additional data on patient age, time of day, referrals, socioeconomic status, and admission status. Insights from unscheduled care data should be meaningful rather than misleading.
(Analyst Workshop 19) Kenny Kyles & Stuart McAllan
The document discusses the development of a Qlikview dashboard for emergency departments at Ninewells Hospital and Perth Royal Infirmary. A team including managers, analysts, developers, consultants, and advisors collaborated over 10 months to create a dashboard providing real-time data visualization on emergency department activity, flow, and performance for both staff and patients. The dashboard has helped build health and business intelligence capabilities while providing a strategic and operational overview to support planning and information needs.
(Analyst Workshop 19) Robyn Pascoe & Helen Wallace
The Royal Infirmary of Edinburgh implemented changes to improve patient safety and care provider time. Nurses were previously spending 15 minutes per shift collecting data for department safety pauses. Now, mini pod pauses are spent on the floor focusing directly on patient safety issues. Department safety pauses are also more efficient, quickly reviewing real-time data and then focusing on patient safety. A flow nurse uses a real-time dashboard to direct patient allocation to pods, improving workload sharing across the department. Staff feedback indicates the changes allow greater focus on direct patient care during safety pauses and enhance overall patient safety.
(Analyst Workshop 19) Milne Weir & Katy Barclay
This document discusses joining up healthcare data to provide insights and improve service delivery. It describes a clinical response model that classifies emergency calls into categories (purple, red, amber, yellow, green) based on predicted clinical need and dispatches the appropriate response. Charts and data are presented on emergency demand, general practitioner demand, ambulance responses, common conditions, and demographics to inform planning. Emerging themes for the future are identified, including using data and digital tools to improve population health, develop alternative care pathways, and enhance workforce development. Questions are posed on how to jointly analyze data over time, identify areas for focus and improvement, and create optimal conditions for delivery and change.
(Analyst Workshop 19) Laura Kelso
The document outlines a 12 hour breach review conducted by Laura Kelso, an improvement advisor for NHS Ayrshire & Arran. It includes a table showing the number of patients breaching at different hours of the day from Monday to Sunday. The review found high numbers of patients breaching between hours 16 to 21 across most days of the week.
(Analyst Workshop 19) Callum Alexander
The Immediate Assessment Unit at Queen Elizabeth University Hospital was regularly exceeding its capacity, with attendances often outweighing the available space. Morning attendances tended to have higher acuity and be more likely to require admission. This caused the unit to physically run out of space between 15:00-21:00. A test of change proposed removing 3 beds to create "ring fenced" trolleys for triage category 3 patients and using the seminar room as a sub wait area. Data on patient movements and occupancy was collected through TrakCare to evaluate the outcomes of redistributing space and implementing a "see and treat" model for category 3 patients. The results and analysis aimed to ensure assessment space was available all day
(Analyst Workshop 19) Andrew Massie
A&E attendances have increased by 22k, 21k and 38k in the last 3 years at core hospitals in Scotland. Emergency admissions have also risen 5% from 2013/14 to 2017/18, while zero length of stay emergency admissions are estimated to be up 21% from 2014/15 to 2017/18. The document analyzes A&E attendance data from January and February 2018 and 2019, finding increased pressure from respiratory conditions in children during those months but limited diagnosis data available at the national level to explain rises in adult attendances.
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- 1. The innovation of data to inform UC NATIONAL EVENT AUGUST 2019 KAREN MORROW UNSCHEDULED CARE PROGRAMME MANAGER
- 2. Relevance of Data in Unscheduled Care NHS Board - 3 Acute site Variance across the hospitals – specialties /capacity Duty manager role – pause tool Real time data to inform
- 3. Discovery Period Review what existed Validity of information Did it tell us what we needed to know? What additional information was available ? Could visual tool/dashboard be improved ?
- 4. ED Information – OLD STYLE
- 5. Developing Dashboard Information analysts team ED staff Service Improvement roles Duty managers Testing, testing, testing AGREEMENT – what was relevant or not
- 6. ED Information – NEW DASHBOARD Unscheduled Activity Data & Graphs Present Day Past 8 days ED Demand Time to Asses Breach Risks Bed Request
- 7. ED Information – NEW DASHBOARD Filter individual sites ED fullness Receiving bed capacity Arrivals by hour ED Demand Triage Categories Time to Asses Breach data Bed Request
- 8. ED Information – NEW DASHBOARD 8 day activity Attends / breaches Breach Cause Pareto Journey time stamps Patient Outcomes
- 9. Summary Key people to be involved Needs to keep evolving WHAT NEXT? Arrival predictors Review ED Trak care options (breach detail)