Transcript Slide 1

MANAGING PRESSURES IN AN
ACUTE SETTING
Grant Archibald
Director Emergency Care & Medical Services
10TH JUNE 2011
A Short Introduction to Queuing Theory
AndreasWillig
July 21, 1999
The subject of queuing theory can be described as follows:
consider a service centre and a population of customers, which at some times
enter the service centre in order to obtain service. It is often the case that the
service centre can only serve a limited number of customers. If a new customer
arrives and the service is exhausted, he enters a waiting line and waits until the
service facility becomes available. So we can identify three main elements of a
service centre: a population of customers, the service facility and the waiting line.
Managing Pressures in an Acute
Setting
Key Parameters
• NHSGGC - 9 Acute Hospital Sites
• 465,000 A&E attendences per year
• 161,000 emergency admissions per year
Managing Pressures in an Acute
Setting
NHSGGC - UNSCHEDULED CARE COMPLIANCE BY MONTH - APRIL 2006 TO APRIL 2011
100%
98%
96%
% COMPLIANCE
94%
92%
90%
88%
86%
84%
82%
80%
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Managing Pressures in an Acute
Setting
UCC Performance
Chart shows a steady build up of performance figures as improvement
work begins to take effect in the departments :
• April 2006 – 81% compliance
• December 2007 – 98% compliance achieved for the first time
• 98% achieved in 18 of the following 22 months as
improvements are embedded and sustained
• Numbers of attenders and admissions increasing in A&E
across NGSGGC
However, it also shows a recent period of decline and then partial
recovery – what has changed?
Managing Pressures in an Acute
Setting
System pressure builds through 2010/11 (1):
• Pressures re Delayed Discharges
• Patients moving more slowly through the system
• ASR - Re-design of Services
• Winter Pressures
– Extreme snow fall/freezing icy conditions
– Increased number of H1N1/Flu like/Respiratory illnesses
Managing Pressures in an Acute
Setting
System pressure builds through 2010/11 (2):
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Significant increase in emergency activity and admissions
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A&E attenders
– 24th December to 7th January 2011: 5% increase on previous year
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Emergency Admissions
– 25th December to 7th January 2011 : 9% increase on previous year
– 1st to 3rd January : 17% increase on previous year
– 3 days when emergency admissions exceeded 500 patients
– 3 days when emergency medical admissions exceeded 300 patients
• Continued attender and admission pressures through most of
January 2011
Managing Pressures in an Acute
Setting
NHSGGC - TOTAL EMERGENCY ADMISSIONS BY DAY
24 DEC - 07 JAN
550
EMERGENCY ADMITS PER DAY
500
450
400
2009-10
2010-11
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300
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Managing Pressures in an Acute
Setting
Response to managing key pressures in system (1)
Immediate :
•Implemented Escalation Policy
•Opened additional capacity
•Increased Home Visiting by GPs/Primary Care services
Longer Term :Understand Changes in Demand profiles
•Continuing to progress planned improvements in length of stay and bed usage
•Ongoing management of delayed discharges
•Reviewing plans to deal with any exceptional peaks in emergency activity
•EDD
•Reviewing Outcomes of A&E Patient Audit and Inequalities Audit
•A Review of all out of hospital measures – HEAT 10 Work Programme
Managing Pressures in an Acute
Setting
Response to managing key pressures in system (2)
•System wide Improvement Action Plan for Unscheduled Care (ATOS)
•March 2011 – Flow Mapping
•Local team engagement to identify patient processes
•May 2011 – Stakeholder Engagement Event – whole system
•Presentation of data analysis
•Identified key priority issues to be addressed
•17th June 2011 – Stakeholder Event to agree future workplan
Issue Tree
Beds = 39%
46% of
admissions < 2
days ALoS
ALoS in Wards 4.7
days
40% of A&E
admissions are
Surgical
Waiting
A&E = 16%
Reasons for
breach
Surgical = 3%
Waiting
Specialist =
12%
20% of Medical
processed in last
30 mins & getting
better
Capacity vs Demand
mismatch (1st Dr
Assessment is 14%)
People & Process?
Other = 2%
Clinical
Exception =
14%
27% of Surgical
processed in last
30 mins & getting
worse
Ortho = 2.8%
Medical = 3%
Support
Services =
15%
12% of
Surgical
admissions
breach
8% of Medical
admissions
breach
Transport = 9%
Bloods = 3.6%
Diagnostics = 1.3%
Radiology =
3.6%
Footprint & routings
(layout)
Managing Pressures in an Acute
Setting
WIG - Waiting for Bed 01
140
120
Count of Breaches
100
80
Data 2009
60
Data 2010
40
20
0
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3
Breach Hour (Arrival Hour + 4 Hours)
Managing Pressures in an Acute
Setting
Key Issues identified at Stakeholder Engagement Event
CAPACITY MANAGEMENT
• Improve accuracy and use of predictive tools
• Match staffing and services to demand profile
• Set capacity parameters for all service flows
Managing Pressures in an Acute
Setting
Key Issues identified at Stakeholder Engagement Event
WHOLE SYSTEMS APPROACH
• Joined up performance targets for Acute services,
Primary Care, SAS and NHS 24
• Re-emphasis on unscheduled care being a whole
service target
• Review arrangements for chronic disease management /
repeat admissions to reduce emergency hospitalisation
Managing Pressures in an Acute
Setting
WAY FORWARD
• Essential to recognise this is not just a product of
extreme winter
• A new paradigm in demand and capacity
• Using structured analysis and tools to devise specific,
hard edged solutions
• Develop a programme of sustained improvement
• Achieve a new steady system-wide steady state, which
is also capable of managing demand variations