urgent and emergency care - nhs dorset ccg...2018/07/10 · urgent and emergency care nhs dorset...
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Supporting people in Dorset to lead healthier lives
Urgent and Emergency Care
NHS Dorset CCG Governing Body meeting 17th September 2014
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Supporting people in Dorset to lead healthier lives
111 Service • 12% increase in calls received and triaged by 111 services
• Recommendations to attend A&E are now 30% (54)above 13/14 monthly
averages with week ending 20/07. • Calls answered within 60 seconds target has been missed on for 4
consecutive weeks from week ending 13/07 to 03/08 corresponding with week on week above average call volumes.
What we know…
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Supporting people in Dorset to lead healthier lives
Ambulance Service • Hear & Treat outcomes have increased by 24% with total calls up 6% • See & Convey has increased by 8% resulting in on average an extra 426
conveyances per month (52% of all attendances) • Red 1 performance above Target at 84.5% for Jun-14 for Dorset CCG
patients. 75% for SWASFT overall
What we know…
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Supporting people in Dorset to lead healthier lives
Emergency Department • Attendances have continued to increase at all 3 acute providers PHT ↑ 11%, RBH ↑ 9%, DCH ↑ 5% • Self-referrals continue to rise especially at PHT & RBH with average
monthly increase of 9.9% (281 attends) at PHT and 8.3% (276 attends) at RBH
• The increase in ED attendances is largely seen in the Out of Hours period at all 3 acutes but PHT also experiencing an In Hours increase (up 6%. 125 per month)
• Increase in MIU attendances now 10% above 2013/14 levels • Emergency admissions up across all providers but greatest in RBH
What we know…
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Supporting people in Dorset to lead healthier lives
Primary care • In hours increases seen in all areas – telephone, GP appointments, nurse
appointments and home visits
• Out of hours service increases seen in calls, urgent care centre attendances and home visits.
• Complexity of patients increasing
What we know…
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Supporting people in Dorset to lead healthier lives
King’s Fund/Oak Group review indicated:
• Higher emergency admission rates than average • High zero length of stay rates • Lower rates of ED attendance • Complex out of hospital picture
What we know…
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Supporting people in Dorset to lead healthier lives
Ambulance Service
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Supporting people in Dorset to lead healthier lives
Emergency Department (A&E)
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Supporting people in Dorset to lead healthier lives
• Increase in activity across all sectors
• Increase in ‘front door’ demand unexplained
• Greatest pressures seen out of hours, particularly weekends • Pressures on the system unsustainable
• Urgent care ‘summit’ held on 29th August 2014
Overview
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Supporting people in Dorset to lead healthier lives
• Assessment of plans against the ‘Acute and emergency care: prescribing
the remedy’ paper • Emergency Care Intensive Support Team (ECIST) supporting ‘front door’
analysis and development of the urgent care dashboard • Establishing sector based task groups • Operational Resilience and Capacity Planning • Transition of Urgent Care Board to System Resilience Group • Anticipatory care plans and special messages • Over 75s plans
Current actions
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Supporting people in Dorset to lead healthier lives
• Audit at ED ‘why are you attending?’ • Improve communications between SWAST and acutes – availability of
consultants that ECPs/paramedics can call • Review hospital transfers – high between RCH and PGH • Reduce the number of admissions from nursing homes • Promote use of MIUs – look at opening hours • Hold sector based summits with primary care • Promote use of SPOA – expand to include social care and voluntary sector • Reduce batching of ambulances – smooth the flow
‘Summit’ actions
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Supporting people in Dorset to lead healthier lives
Summary
• Front end activity up (including primary care)
• Demographics haven’t changed
• Need to consider – here and now, longer term strategy