Frailty Capacity Modelling in West Lothian
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Frailty Capacity Modelling in West Lothian

Neil Pettinger / 21 April 2015. A&E. Assessment. A&E. Wards. Assessment. A&E. Homecare. Wards. Assessment. A&E. How . many?. Homecare. Wards. Assessment. A&E. How. long?. How .

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Frailty Capacity Modelling in West Lothian




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Presentation on theme: "Frailty Capacity Modelling in West Lothian"— Presentation transcript:

Slide1

Frailty Capacity Modelling in West Lothian

Neil Pettinger / 21 April 2015

Slide2

Slide3

A&E

Slide4

Assessment

A&E

Slide5

Wards

Assessment

A&E

Slide6

Homecare

Wards

Assessment

A&E

Slide7

How many?

Homecare

Wards

Assessment

A&E

Slide8

Howlong?

How many?

Homecare

Wards

Assessment

A&E

Slide9

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

Slide10

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Slide11

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Slide12

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

148

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Slide13

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

151

minutes

148

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Slide14

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

148

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Slide15

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

148

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

Slide16

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

148

attendances

29

hours

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

Slide17

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

148

attendances

29

hours

33

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

Slide18

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

26admissions

148attendances

29

hours

33

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide19

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

26admissions

148attendances

6.1days

29

hours

33

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide20

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

26admissions

148attendances

6.1days

29

hours

157

patients

33patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide21

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014: Boarding Levels

Slide22

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29

hours

157

patients

33patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide23

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29

hours

75minutes

157patients

33patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide24

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29

hours

75minutes

157patients

33patients

2,125hours

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Slide25

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29

hours

75minutes

157patients

33patients

2,125hours

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Calendar Year 2014 /

Four-hour compliance: 94.6%

Slide26

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014: Boarding Levels

Slide27

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide28

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide29

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide30

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

168

minutes

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide31

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

168

minutes

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

138

minutes

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide32

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

138

minutes

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide33

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide34

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide35

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide36

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

30

hours

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide37

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

30

hours

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

29

hours

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide38

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

29

hours

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide39

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

151

attendances

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide40

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

26

admissions

142

attendances

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide41

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

25

admissions

26

admissions

142

attendances

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide42

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

6.3days

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

25

admissions

26

admissions

142

attendances

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide43

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

6.3days

30

hours

34

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

25

admissions

26

admissions

142

attendances

6.2days

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide44

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

6.3days

30

hours

160

patients

34patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

25

admissions

26

admissions

142attendances

6.2days

29

hours

32

patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide45

How

full?

Howlong?

How many?

Post Acute

Wards

Assessment

A&E

18patients

168minutes

27

admissions

27admissions

151attendances

6.3days

30

hours

160

patients

34patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

COMPARE AND CONTRAST

How

full?

How

long?

How

many?

Post Acute

Wards

Assessment

A&E

14

patients

138

minutes

25

admissions

26

admissions

142attendances

6.2days

29

hours

155

patients

32patients

“Worst” 91 days of 2014 (88% compliance)

“Best” 91 days of 2014 (99% compliance)

Slide46

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

Medical “downstream” occupied beds per day, calendar year 2014

Slide47

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

Medical “downstream” occupied beds per day,

91 good days

in calendar year 2014

Slide48

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

Medical “downstream” occupied beds per day,

91 bad days

in calendar year 2014

Slide49

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAY /

Medical “downstream” occupied beds per day,

good

&

bad

days

, calendar year 2014

Slide50

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

How full?

If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

STEP 1: Better performance against the four-hour target

Slide51

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

How full?

If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many?

Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

STEP 1: Better performance against the four-hour target

Slide52

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

6.0

days

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

How full?

If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many?

Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

How full?

can be derived as:

155

÷ 26 = 5.96

(which I’ve rounded up to

6.0

days for the purposes of the grid)

STEP 1: Better performance against the four-hour target

Slide53

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

6.0

days

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

How full?

If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many?

Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

How full?

can be derived as:

155

÷ 26 = 5.96

(which I’ve rounded up to

6.0

days for the purposes of the grid)Now let’s remind ourselves of what the actual calendar year 2014 figures were for the third – blue – column…

STEP 1: Better performance against the four-hour target

Slide54

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

15patients

151minutes

26

admissions

26admissions

148attendances

6.1days

29

hours

157

patients

33patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

A&E

data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment

data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward

data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

STEP 1: Better performance against the four-hour target

Slide55

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

6.0

days

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

This difference between 6.1 days and 6.0 days in the average length of stay for the downstream medical wards seems very small indeed.

But it’s worth bearing in mind that it’s just less than 2 hours 30 minutes, and that in order to achieve this reduction, we’d have to reduce

everybody

’s length of stay by 2.5 hours.

Or the equivalent. We’d need to reduce the number of occupied bed days per year by 950 in order to achieve this level of improvement (which would not only enable improved four-hour performance but would also – probably – enable a reduction in length of stay in Assessment that would make

it

less full and which – in turn – would allow the four-hour target in A&E to be met more frequently).

STEP 1: Better performance against the four-hour target

Slide56

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

6.0

days

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

This “ought-to-be” number of 155 includes patients who are occupying beds in the “wrong” wards.

Let’s take a closer look at the boarding that was happening in 2014 in the four main wards that seemed to be “lending” the most amount of beds to Medicine…

STEP 2: Can we reduce the amount of boarding?

Slide57

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

NotesWard 12…

STEP 2: Can we reduce the amount of boarding?

Slide58

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

NotesWard 14…

STEP 2: Can we reduce the amount of boarding?

Slide59

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

NotesWard 15… (which looks more like a Winter Ward)

STEP 2: Can we reduce the amount of boarding?

Slide60

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

NotesWard 18…

STEP 2: Can we reduce the amount of boarding?

Slide61

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

6.0

days

155

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

What boarding means is that – on average – about 15 beds per day of the 155 generated altogether by medical patients are occupied by boarders.

So if we wanted to achieve 98% four-hour performance and have a situation where there were no boarders, we’d need the 155 figure to reduce by 15 to 140.

(Except that 140 beds full on average out of a bed complement of 142 seems a bit on the high side – occupancy-wise: 98.6%. Whereas an occupancy of 137/142 (96.5%) (one empty bed in each of the five wards) seems more reasonable.)

Let’s see what would need to happen for the current ;levels of activity to fit into an envelope of 142 at 96.5% occupancy…

STEP 2: Can we reduce the amount of boarding?

Slide62

How

full?

Howlong?

How many?

Homecare

Wards

Assessment

A&E

26

admissions

5.3

days

137

patients

St John’s Hospital /

MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Notes

Using the same arithmetical logic that we applied before:

137 ÷ 26 = 5.27

(Rounded to 5.3 in the grid)

This shows us what the average length of ward stay would need to be in the downstream medical wards if current levels of activity were to be accommodated without the need for boarding.

It assumes that an average percentage bed occupancy of 96.5% is consistent with good four-hour performance.

It’s important to bear in mind two things here.

One is that the number of ward stays will reduce if boarding is eliminated (because the 2014 figure of 26 per day includes boarding ward-to-ward moves.

The other is that it is likely that a reduction in boarding will of itself likely generate a reduction in length of stay (because we know that boarding is associated with longer length of stay)

STEP 2: Can we reduce the amount of boarding?

Slide63