Accident & Emergency Clinical Quality Indicators
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- Hilary Sherman
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1 These indicators were introduced in April 2011 to present a comprehensive and balanced view of the care delivered by A&E departments. They are designed to accurately reflect the experience and safety of patients, and the effectiveness of the care they recieve. Data from all acute NHS Trusts is published by the Health and Social Care Information Centre (HSCIC), usually with a three month delay. You can access the data from the HSCIC by clicking this link: HSCIC National A&E Data This report is about the services we provide in the: Emergency Department, Wythenshawe Hospital, Southmoor Road, Wythenshawe, M23 9LT Telephone Number: We are a Major (Type 1) A&E department providing a consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of and Major Trauma patients. Summary: Indicator Measure Threshold Attendances More Detail Total time in A&E 95th percentile time 4 Hours 9h 21m 7,696 Page 3 for admitted patients 95th percentile time 12h 56m 2,369 Page 4 for nonadmitted patients 95th percentile time 5h 59m 5,327 Page 4 Time to Initial Assessment (ambulance arrivals) 95th percentile time 15 minutes 17 mins 2,093 Page 5 Time to Treatment median time 1 Hour 73 mins Page 5 Left without being seen percentage 5% 2.75% 7,696 Page 6 Unplanned Reattendance Rate 5% 1.03% Page 6 Ambulatory Care (Proportion of patients admitted by diagnosis in A&E note this includes admissions to our Ambulatory Care Unit where patients do not stay overnight) Cellulitis percentage 33.8% 74 DVT (Deep Vein Thrombosis) percentage 35.3% 34 TIA (Transient Ischaemic Attack) percentage 36.0% 25 Consultant Sign Off percentage # TBC # Friends and Family percentage 97% Page 2 Actual
2 Summary of Indicators: Patient Pathway Initial Assessment Treatment Total time in A&E Consultant Sign Off Patient arrives at A&E 95% of patients arriving by ambulance waited under 17 minutes from arrival to initial assessment On average, patients waited 73 minutes from arrival to treatment 95% of patients waited under 561 minutes from arrival to departure 95% of patients not requiring admission to hospital waited under 358 minutes from arrival to departure 95% of patients who needed admission to hospital waited under 775 minutes from arrival to departure TBC% of high risk patients were seen by an emergency consultant before being discharged from A&E Left without being seen Ambulatory Care ReAttendance 1.03% of attendances were unplanned reattendances within seven days of original attendance 2.75% of attendances this month left the department before being seen 66.2% of patients with cellulitis 64.7% of patients with DVT, and 64.0% of patients with TIA were treated without the need to be admitted overnight Service Experience The Friends and Family Test score in March 2016 for this A&E department is 82.2% (This is the % of patients who would be likely or extremely likely to recommend this A&E Department to a friend/family member, the target is 97%). This is based on 1039 responses. (A Response Rate of 17.1%, the target is 40%) Page 2 of 7
3 Attendances & Admitted (Count) Total time spent in the A&E dept (minutes) Number of Patients attending the A&E department Shown here to give context to the other indicators 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 Total time spent in the A&E department (All Patients) Aim: To improve the timeliness and monitoring of care to ensure patients do not have excessive waits in A&E before leaving the department Attendances Admitted 95th Percentile Median (95th Percentile) The above graph shows the average number of new attendances per day in the ED, by month. It also shows the number of these attendances who were admitted to hospital. The above graph shows the median and 95th percentile time spent in the emergency department (in minutes). The performance target is for 95% of patients to spend less than 240 minutes (4 hours) in the Emergency Department. In April 2016 we treated 7,696 new A&E attendances. We admitted 30.8% of attendances to hospital. In April 2016, 78.35% of patients attending the department left within four hours. Page 3 of 7
4 Total time spent in the A&E dept (minutes) Total time spent in the A&E dept (minutes) Total time spent in the A&E department (Admitted Patients) Aim: To ensure patients do not have excessive waits in A&E before leaving the department to be admitted to a ward. 900 Total time spent in the A&E department (NonAdmitted Patients) Aim: To ensure patients do not have excessive waits in A&E before leaving the department Monthly 95th Percentile (95th Percentile) Monthly 95th Percentile (95th Percentile) The above graph shows the 95th percentile time spent in the emergency department (in minutes) for all patents who were subsequently admitted to an inpatient bed at UHSM. The performance target is for 95% of patients to spend less than 240 minutes (4 hours) in the Emergency Department. In April 2016, we admitted 30.78% of all our new A&E attendances, on average 79 per day. The 95th percentile stay in the Emergency Department for these patients was 775 minutes. The above graph shows the 95th percentile time spent in the emergency department (in minutes) for all patents who were not subsequently admitted to an inpatient bed at UHSM. The performance target is for 95% of patients to spend less than 240 minutes (4 hours) in the Emergency Department. In April 2016, 69.22% of all our new A&E attendances were treated without being admitted to UHSM, on average 178 per day. The 95th percentile stay in the Emergency Department for these patients was 358 minutes. Page 4 of 7
5 Time to Initial Assessment (minutes) Time to Treatment (minutes) Time to Initial Assessment (Ambulance Arrivals) Time to Treatment Aim: To reduce the clinical risk associated with the time the patient spends unassessed in A&E. 25 Aim: To minimise the time patients spend before their treatment begins in A&E Monthly 95th Percentile (UHSM) Monthly Median (UHSM) The above graph shows the time by which 95% of patients arriving at UHSM A&E by ambulance were assessed in the A&E department. The performance target is for 95% of patients who arrive by ambulance to be assessed within 15 minutes. In April 2016, 95% of patients arriving at UHSM A&E by ambulance were assessed in the A&E department within 17 minutes. In April 2016, 2,093 patients arrived at A&E by ambulance (an average of 70 per day). This represents 27.2% of our A&E attendances. The above graph shows the median time patients spend before their treatment begins in A&E. The performance target for Time to Treatment is for the median time to be within 60 minutes. In April 2016, the median time patients spent in the A&E department before their treatment began was 73 minutes. Page 5 of 7
6 Left without being seen rate 7 day unplanned reattendance rate Left department without being seen for treatment Aim: To improve patient experience and reduce the number of patients who leave A&E before receiving the care they need. 6.00% Unplanned reattendance at A&E within seven days Aim: To reduce avoidable reattendances at A&E by improving the care and communication delivered during the first attendance. 6.00% 5.00% 5.00% 4.00% 4.00% 3.00% 3.00% 2.00% 2.00% 1.00% 1.00% 0.00% 0.00% Monthly Rate (UHSM) Monthly Rate (UHSM) The above graph shows the proportion of A&E attendances who left the department before being seen. The above graph shows the percentage of new attendances at A&E who reattended the department within seven days of the original attendance (unplanned), including where the initial attendance ends with admission, transfer or referral to other health professional. In April 2016, 2.75% of patients who attended A&E left before being seen. The performance threshold for this is 5% In April 2016, 1.03% of attendances reattended the department (unplanned) within seven days of original attendance. The performance threshold for this is 5% Page 6 of 7
7 Rate A&E attendances for Cellulitis, DVT and TIA that end in Admission Consultant Sign Off Aim: To improve the provision of ambulatory care and reduce avoidable hospital admissions % This indicator uses information that will be made available as part of the College of Emergency Medicine's clinical audit programme; this will be included in the dashboard as it becomes available (No threshold) 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Admission rate for Cellulitis Admission rate for Deep Vein Thrombosis (DVT) Admission rate for Transient Ischaemic Attack (TIA) The above graph shows the proportion of patients diagnosed with cellulitis, DVT or TIA in the A&E who are admitted to hospital. Note that recorded admissions include where we provide care in our Ambulatory Care Unit without the patient staying overnight. Note this includes only patients diagnosed with these conditions in the A&E department, and definitive diagnosis may be made later. In April 2016, 33.78% of patients with Cellulitis were admitted, 35.29% of patients with DVT were admitted, and 36.00% of patients with TIA were admitted. of 7
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