Geraldine Marsh Service Improvement Manager Emergency Access NHS Lanarkshire

Geraldine Marsh Service Improvement Manager Emergency Access NHS Lanarkshire

Emergency Response Centre GP interface Intelligence Centre

GP Interface

Emergency Care Model Alternatives to admission Direct Referral to Specialty Units / Wards (protocol driven) Surgical Assessment Unit Scottish Ambulance Service See & Treat for minor injury and illness Emergency outpatient area Urgent clinics? Outpatient IV antibiotic therapy Specialty Wards/Units Primary Care & Out of Hours Centres NHS 24 Self referrals Emergency Response Centre A & E Paediatric area for minor & major illness Resuscitation Bays Common Assessment Area Medical Assessment Unit Acute Care of the Elderly Assessment Unit Discharge Lounge Outpatients awaiting investigation Inpatients Clinical Decision Unit (Maximum 24hr stay) Short Stay Beds (Maximum 48hrs stay) Short Stay Beds (Maximum 48hrs stay) Cardiology Respiratory Gastroenterology Diabetes/ Endocrinology Renal Infectious Diseases Rheumatology Haematology Dermatology Care of the Elderly Wards ICU CCU / Catheterization Lab Medical HDU

Progress Opened November 2008 5 days per week, 8am to 6pm Freephone Tel. No Handle all emergency Medical and general Surgical GP calls Arrange transport when required

Objectives Stream patients to appropriate point of care Explore alternatives to admission Appropriate use of resources (avoid duplication) More efficient use of SAS vehicles Incorporate discharge dispatch and community care

Central bed bureau Clinical pathways / protocols in liaison with primary care Establish joint management algorithms with SAS, NHS 24 and OOH Social work / community care link up Develop alternatives to admission Acute care; urgent access to specialist, programmed investigation unit, etc.) Primary care; next day GP clinic, district / specialist nurse input

Phase I Standardisation of GP Emergency Calls to Acute Standardised system for live monitoring of bed availability across Lanarkshire Community Paramedic joint working within ERC

On average 375 calls per week (73 per day) Calls answered within 12-18 seconds (average call duration 2.08 min) Busiest period 10am to 1pm 3 to1 ratio between medical and surgical patients Transport required in 42% of patients

Phase II Develop prompt alternatives to admission facilitated by the ERC e.g. RADAR, Day Hospitals, Urgent OP appointments, imaging appointments. Evidence the development, application and benefits of the use of referral pathways by the ERC for patients who present as emergency cases via 999 and NHS24

Phase III Increase pool of staff able to rotate through different posts in unscheduled care, including NHS 24. Explore options to extend NHS 24 s systems and processes to support NHS Lanarkshire, specifically the Knowledge Management System.

Alternatives to admission AF pathway Respiratory urgent assessment in community by nurse specialist Rapid access to day hospital for elderly patients Urgent access to DVT service Availability of consultant advice

Alternatives to admission Month Total No calls taken Medical referrals for assessment Surgical referrals for assessment Alternatives to admission offered Alternatives to admission used January 1541 916 314 116 32 February 1409 887 309 51 20 March 1667 1033 371 49 23

Intelligence Centre

E R Early identification of pressure Rapid communication across NHS L C Control of the whole system

Real time information Focused management Whole system deployment Immediate escalation and problem solving Re- prioritisation Constant state of readiness

How is it achieved? The ERC deciphers the problems

Plans the Strategy

Is in constant state of readiness

Deploys the troops

Every day a battle!!

Daily Performance Report NHS LANARKSHIRE (ACUTE DIVISION) PERFORMANCE REPORT date Overal Status NHS Lanarkshire (Acute Division) 09.30am 15.30pm RED Amber Green Previous 48 hrs Overal Status Lanarkshire 24hrsam pm 48hrsam pm RED Amber Green SUPPORTING EVIDENCE ACUTE DIVISION Hairmyres Monklands Wishaw Total No. of Breaches (from Midnight) 4 Hours 0 8 Hours 0 12 Hours 0 Reason Codes Previous Days UCCP Performance (4 hours) 0% Total number of previous days Emergency Department attenders 0 No. of patients in Emergency Departments (9.30am / 14.30pm) 0 No of Staffed Bed Available within DGH (Beds available after all elective activity & current emergencies have been placed) 0 Medical 0 Surgical 0 No of staffed beds available outwith DGH 0 No. of additional beds open Medical Surge Beds 0 Surgical Surge Beds 0 Number of CCU beds Available 0 Number of ITU beds Available 0 Number of Surgical HDU beds Available 0 Number of Medical Decants Predictor Predicted Admissions 0 Predicted Discharges 0 Variance 0 Previous Days Actual Admissions 0 Previous Days Actual Discharges 0 Staffing Issues Nursing - See & Treat Emergency Care Wards Departments

Conference Call Vital Signs Previous days performance Patients in A&E including breech time Available beds by specialty HAI Issues and H1 N1 Staffing issues Predicted admissions and discharges Medical Decants Overall Risk status

The Results 4 hour Emergency Access Standard 99.5 99 98.5 98 97.5 2008/09 2009/10 Target 97 96.5 96 Dec Jan Feb