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ANALYTICAL APPROACHTO SUPPORT THE URGENT CARE

AGENDA

Joe Clancy - Change & Innovation Manager - NHSL - 16 December 2008 - V2

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2007/08 - Drivers in NHSL

Emergency Response Centre (ERC)• Will establish closer working arrangements

between the Scottish Ambulance Service, NHS 24, Out of Hours services and NHS Lanarkshire to provide a more integrated emergency service

Get the patient to the right place first timeMulti agency

• Referenced in BHBC

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More about the ERC

• Pilot Project for emergency GP referrals

• Developed in 2007 and 2008

• Implemented in November 2008

• Monitor and evaluate over 2 /3 yearsEstablish evaluation baselinesMulti agency evaluation criteria and

performance indicators

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Work in NHSL over the last year

• Service demand review - SAS/NHS24/OOH• SAS emergency call review• Review of inter hospital transfers (IHT) by SAS• Review of trends in emergency admissions• Emergency care workforce planning - A&E

activity review

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What we have learned

• Is hospital based info fit for purpose?– e.g. referral source type and recording– e.g. diagnosis and outcome

• Multi agency systems tell us different things (but fit for own purpose)– No direct linkages across the systems– Multi agency systems do not always reconcile

• Gaps in the information that is required– e.g. routine recording of GP emergency referral phone contact

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What we need to do – high level

Need to understand before we act– How choice is made – which queue to join– Steps in and out of the emergency pathway– Outcomes

Suggestion - first steps to do this ……..– Produce a composite matrix of what information is available to

each agency– Comprehensively link patient flow data across individual agency

systems – use proxy measures where necessary– Beneficial to link datasets at national level

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NHSL High Level Demand MatrixChange & Innovation NHSL

QUANTIFY & QUALIFY

GP IN HOURSINDIV GP PRACT

EXTENDED HOURS

PAN NHSL GP MANAGED

EXTENDED HOURSNHS24

ERC PILOT IN NHSL

SASNHSL OOH

EDIS A&E

ATTENDANCES

EDIS EMERGENCY ADMISSIONS

SMR01 EMERGENCY ADMISSIONS

DISCHARGE & FOLLOW-UP

98 GP practices 32 CIRCA 60Plus 6 ? 2006/07 2006/07 2007/08 2007/08 2007/08 2006/07

Monklands 66,212Wishaw 66,752Hairmyres annual projection annual projection 56,413All NHSL 52,000 126,347 na 62,488 133,347 189,377 43,382 54,397

DEMAND CHANGEGrowth nationally

& locallyGrowth nationally

& locallyGrowth nationally

& locally

Sizeable growth over the last 2

years

Sizeable growth in med adms over the last 2 years

DRIVERS OF CHANGE

To follow To follow To follow To follow To follow To follow To follow To follow To follow To follow To follow

STRATEGIC CHANGE IN OTHER NHS BOARDS

To follow To follow To follow To follow To follow To follow To follow

MANAGING DEMAND PROSPECTIVE IMPLICATIONS

To follow To follow To follow To follow To follow To follow To follow To follow To follow To follow To follow

COMMENTSNeed to quantify

impact on emergency access

Need to quantify impact on

emergency access

Numbers from similar referral sources vary

GP contact onlyNumbers from similar referral sources vary

Numbers from similar referral sources vary

Numbers from similar referral sources vary

Excludes direct admissions

Includes direct admissions

INFORMATION SOURCES

LocalNational & Refional

SAS NHS24 NHSL

National LocalLocal in detail National - high

level

Local in detail National - high

level

Local & National in detail - linked data nationally

INFORMATION AVAILABILITY

Ongoing Current

New TBC

New TBC

Since October 2004

New Pilot starts mid November 2004

Ongoing Current

Since October 2004

Ongoing Local in detail National - high

level

Ongoing Current

Ongoing Current

INFORMATION DEVELOPMENT

SAS to specify

Proposed expansion of National A&E

dataset

PERFORMANCE MEASURES

Set locally HEAT Local HEAT HEAT

ACCESS TO EMERGENCY CARE - WHOLE SYSTEM APPROACHNHSL HIGH LEVEL MATRIX FOR DEMAND RECONCILIATION

TO UNDERPIN DEVELOPMENT & IMPLEMENTATION OF OVERARCHING NHSL CLINICAL MODEL

CONTACTS PRESENTATIONS ADMISSIONS

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Some Current NHSL WorkCatchment Management Perspective - GP Practice Level

Who goes where and why?• Opportunities for re-aligning emergency flows

– to alleviate pressures

• Using Building Blocks– e.g. 98 practices, 9/10 localities, 2 CHPs, 3 acute hospitals, 12 SAS

stations

• Compare standardised attendance & admission rates– Benchmark nationally

• Utilise NAVIGATOR– Emergency admission and bed day rates

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Annual Demand in NHSL

• Contacts with NHS24/OOH - C 130,000

• SAS emergency incidents - 65,000

• A&E attendees - 190,000

• Acute emergency admissions - 55,000

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NHSL Recent A&E Trends - 1

NHSL ANNUAL A&E ATTENDANCES - ALL FLOW GROUPS

177,099

187,349

191,256

170,000

175,000

180,000

185,000

190,000

195,000

2005/06 2006/07 2007/08

+6%

+2%

INCREASE OF CIRCA 14,000 OR 8% OVER 2 YEARS

WHAT ARE THE DRIVERS OF CHANGE ?

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NHSL Recent A&E Trends - 2

NHSL ANNUAL A&E ATTENDANCES BY FLOW GROUP

116,894 118,839

20,91625,766 29,035

25,25428,346

30,18814,035

13,97013,194

119,267

0

50,000

100,000

150,000

200,000

2005/06 2006/07 2007/08

PFG1 Minor Injury & Illness PFG2 Acute Assessment

PFG3 Medical Admissions PFG4 Surgical Admissions

-6%

+20%

+39%

+2%

DRIVERS OF

CHANGE

CAUSE??

NEED TO DETERMINE

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NHSL Recent A&E Trends - 3

NHSL ANNUAL A&E % DISTRIBUTION BY FLOW GROUP

66% 64% 62%

12% 14% 15%

14% 15% 16%

8% 7% 7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005/06 2006/07 2007/08

PFG1 Minor Injury & Illness PFG2 Acute Assessment

PFG3 Medical Admissions PFG4 Surgical Admissions

MINUS

PLUS

PLUS

MINUS

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NHSL - SAS IHT Trends

SAS INTER HOSPITAL TRANSFERS (IHT) TRENDS - NHS LANARKSHIRE

4,080

3,879

4,213

4,492

3,500

3,600

3,700

3,800

3,900

4,000

4,100

4,200

4,300

4,400

4,500

4,600

2004/05 2005/06 2006/07 2007/08

10% INCREASE