nhs borders development of escalation policy dr. simon watkin consultant respiratory physician...
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NHS BordersDevelopment of Escalation Policy
Dr. Simon WatkinConsultant Respiratory Physician
Borders General Hospital
Setting
• NHS BordersBorders General HospitalPrimary and Community ServicesMental HealthSocial ServicesScottish Ambulance ServicePartnership forum
• Population 106,500• 280 beds total• 102 GIM beds including 30 MAU and 12 HD• 30 DME, 30 stroke/palliative/community
NumbersGeneral Surgery Admissions and Discharges over a 15 month period
0
50
100
150
200
250
300
Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10
Period
Num
ber o
f Epi
sode
s
ADMISSIONS DISCHARGES
General Medicine Admissions and Discharges over a 15 month period
400
450
500
550
600
650
700
750
800
Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10
Period
Num
ber o
f Epi
sode
s
ADMISSIONS DISCHARGES
Length of stay
NHS Borders
X Chart showing average length of stay in General Medicine15 MONTHS
2
3
4
5
6
7
Jun
-09
Jul-
09
Au
g-0
9
Se
p-0
9
Oct
-09
No
v-0
9
De
c-0
9
Jan
-10
Fe
b-1
0
Ma
r-1
0
Ap
r-1
0
Ma
y-1
0
Jun
-10
Jul-
10
Au
g-1
0
Se
p-1
0
Oct
-10
No
v-1
0
De
c-1
0
Period
Ave
rag
e L
en
gth
s o
f Sta
y
Trajectory Scottish Average Performance 2008 - 09
Why might you need an escalation plan?
• 95+% bed occupancy• Delayed and cancelled surgery• 4 hour waiting breached• Medical boarders• Norovirus• Severe weather• Influenza
Development of Escalation Policy
• Executive support• Large scale 1 day event• Small working group weekly• Agreed policy• Executive mandate• Implementation group• “Thin” policy document• Clear operational arrangements
Who was involved?• AHPs• Bed Management• BGH Clinical Board• Borders Emergency Care Services• Borders Improvement Support
Team• Communications Team• Community Hospital
Superintendents • Discharge Liaison• Domestic and Portering Services • Infection Control
• IM&T• Mental Health Clinical Board• PACS Clinical Board• Pharmacy• Planning and Performance• Public and Patient
Representatives• Scottish Ambulance Service• Scottish Health Council • Social Work• Voluntary
Timescale
• Concept April• Workshop June• Executive approval August• Implementation October
Positives
• Creative and innovative• Multi professional• Alignment of objectives• Better, safer treatment• Efficient• Cost effective
Now what?
• Implementation group• Data quality• Action cards• Patient flow action team• Monitoring• Trial period• Re-assess• Re-calibrate
Colour Capacity Level of Concern for Service
Delivery
Black No capacity to meet actual unscheduled demand
Critical
Red Insufficient capacity to meet predicted planned and unscheduled demand
Severe
Amber Limited capacity but discharges are predicted
Moderate
Green Sufficient capacity to meet predicted planned and unscheduled demand
Nil / Minor
Status at Midnight
Treatment Capacity
Staffing Levels
Support Services
Risk Levels
Repatriation / Boarders
Board Status
Colour ActionBlack All staff are required to contribute to
managing this through direction from Patient Flow Action Team.
Red All those with roles and responsibilities outlined in Action Cards must prioritise these over normal duties.
Amber Limited number of staff involved in actions as directed through the Clinical Boards.
Green No requirement for actions in additional to normal procedures.
How do we set the whole system status?
Red Red RedAmber Red Red
Amber Amber RedGreen Red RedGreen Amber RedGreen Amber AmberGreen Green Red
Green Green AmberGreen Green Green
What’s next?
• Have we got the thresholds correct• Can all groups react in real time• Will we learn anything we do not already
know• Equitable spread of risk• Common understanding
"If you are too good at adjusting to the current system, you may never realise that the system needs changing“
Edward de Bono