Review of the Cardiff Masters EU Projects with Aneurin Bevan University Health Board

Danny Antebi, Paul Harper, Julie Vile & Janet Williams

Masters students: Elizabeth Allkins, Yiwen Fu

Overview

Background on links between Cardiff University & ABUHB

Brief overview of the two Unscheduled Care Masters Projects

Project feedback to the Health Board

Outcomes and sustainability of the work

Questions

ABUHB – Aneurin Bevan University Health Board

14 hospitals in total, 2 major A&E

Serves an estimated population of over 639,000, approximately 21% of the total population of Wales

Employing over 13,000 staff, two thirds of which are involved in direct patient care

ABCi – Aneurin Bevan Continuous Improvement

The Modelling Unit

John Frankish – Service Lead/Improvement Coach

Dr Tracey England – Mathematical Modeller

Dr Penny Holborn - Mathematical Modeller

Dr Izabela Komenda – Mathematical Modeller

Dr Julie Vile - Mathematical Modeller

Terry Watkins – Improvement Coach

Mr Hiro Tanaka – Clinical Liaison/Support

Steve Elliott – Financial Support

FunctionsRange from informal advice to analytical support

Variety of mathematical techniques permit best option approach for any project:

Focus - Current ProjectsUnscheduled care:

Modelling demand and capacity for OoH services Improving the accuracy of predictions for RGH ED Aligning staffing profiles to peaks and troughs in demands for RGH ED Improving patient flow Evaluating the effect of individuals presenting in ED under the influence of

alcohol

Mental health: CHMTs skill mix and staffing levels Developing caseload management tool Analysis of CHC packages over a 5 year period

Pathology: The effects of changing the shift patterns in the laboratory at the RGH

Primary care: Evaluating the introduction of a Patient Access system for GPs scheduled care

Scheduled care: Development of a fracture neck of femur database tool

Informatics: Digitalisation of Health Records

Masters Projects

Short-term projects (3 months)

Outputs:

Presentation

Executive summary

20,000 word dissertation!

Unscheduled Care

TOO MUCH DEMAND

PROCESSES ARE TOO SLOW IN HOSPITAL

LACK OF CAPACITY TO TAKE PATIENTS OUT

OF SYSTEM

• Admission avoidance strategies

• Better community model

• Role of WAST

• Consultant at front end

• Alternative pathway for elderly/ frail patients

• Co-locate MIU

• Better computational facilities

•Discharge patients earlier

• Bring in elective patients later

• 24/7 working

• Patient boarding

Modelling patient flow in ED to better understand demand

management strategies.

Elizabeth Allkins

Sponsor Supervisor – Danny Antebi

University Supervisors – Dr Julie Vile and Dr Janet Williams

Aims

Gain insight into the functioning of the Emergency Department in the Royal Gwent Hospital

Explore the effect on the system of actions to redistribute demand, reduce overcrowding and long waiting times

Background

4 hr Breaches & Death Rate

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4 hour breaches

Death rate

Two complementary approaches

Reduce attendance at ED

Improve flow through ED

Stats analysis: Length of Stay

DES Simulation modelInput Parameters – easily changed via spreadsheet

Resources

Staff Nurses Doctors Call handler Receptionist

Beds Beds for Majors and wards Rooms for Minors

Xray machine

Validation and Verification processes completed

Final model

What-if scenarios

CDU Use as a ‘fast-track’

stream Use as an additional

ward with 12 extra beds.

What-if scenarios

WAST pre-hospital streaming Streaming ambulance patients direct to the MAU

GP trial Streaming GP referrals to a bed in the MAU

Reduction in WAST conveyance rates Reduction of 10% reduced waiting times

Conclusions

Detailed analysis of ED data

Cost saving of CDU Reduction in Majors LOS

Simulation Demonstrated the power of modelling Explored scenarios to improve waiting times Built a solid foundation for future research

Assessing the impact of an ageingpopulation and the effects of

frailty programmes on RGH

Yiwen Fu

Sponsor Supervisor – Danny Antebi

University Supervisors – Dr Julie Vile & Prof. Paul Harper

Aim and backgroundAim

Evaluation: Impact of aging population on RGH Evaluation: Indirect effectiveness of Newport frailty team on ED Simulation models and scenarios: Estimate impact on patient flow in

ED resulting from realisation of operational LoS and attendance targets

Background Pressure from ageing population in ED Newport frailty team: Established at 11th April 2011; Further developed

at 1st Sept 2011 Main patients source: GP and secondary care

Attendance

Arrival modes

2/3 of patients 65+ arrive by ambulance

2/3 of those under 65 come in a private vehicle

Ambulance 65%

Ambulance19%

Newport population projection

The Frailty programme

Joint service provision across ABHB and the 5 local authorities

Set up in April 2011

Provide intermediate care services Keep people happily independent in their own home Services within Community setting Services within the hospital

Aims Reduce bed days Avoid ED and MAU admissions Reduce need for Continuing Health Care Packages

Impact on ED/MAU attendance ratios

The baseline population is increasing and ageing.

Significant reductions in number of 65+ attending MAU (1st contact): 1,995 (2011/2012) -> 1,884 (2012/2013). Number of patients under 65 remained relatively stable over same period. Early days – some natural variability in system, numbers increased in year frailty

team was initiated. Need to re-evaluate in the future!

Lack of evidence to support a reduction in ED attendances: Numbers and ratios fell for ALL patients except those aged 65-74 between the

‘during’ and ‘after’ period. Possibly some evidence of a small impact - between 2012-2013 the ratios of

patients aged 75+ fell at a more dramatic rate than those under 65. Need to re-evaluate in the future!

Marginal (but not significant) reductions in the assessed-in rate

Newport LoS analysis

Simulation model

Results of simulation

Scenarios results are compared with baseline results Relative large impacts on Major unit

Scenario 1 Reduction on service time (65+ only) Reduction rate is linearly related to performances Gradually improve all performances

Scenario 2 Reduction on attendances (65+ only) Reduction rate is curvedly related to performances Mainly improve queuing size and queuing time

Simulation results

ConclusionsSmall cohort of population but uses a non-equivalently large proportion of resources

Impact of Newport frailty team – need to evaluate in future

Better care management would benefit hospital and patients Introduce a frailty consultant to ED?

Further research Impact of Newport frailty team on MAU/quality of life Apply same techniques to other Local Authorities Need IT software to capture the relevant data More detailed simulation model

Feedback to Heath Board

Aneurin Bevan Continuous Improvement and

Cardiff University Event

Developing Mathematical Models in Healthcare

 

 

Wednesday 11 September 2013

 

Malpas Court, Whittle Drive,

Malpas, Newport, NP20 6NS

Programme

From 13:00

Registration and Coffee

13:30Opening, Welcome and Introduction

Prof. Paul Harper – Head of Operational Research, Cardiff University and Dr Danny Antebi – Director, ABCi

13:40How can the ABCi Modelling Unit support you?Dr Julie Vile – Mathematical Modeller, ABCi

Session 1

13:50

Presentation 1 – Elizabeth Allkins“Admission avoidance strategies to redirect high demands for A&E services in ABHB”

14:15Presentation 2 – Yiwen Fu“The impact of an ageing population on unscheduled care services in ABHB”

14:40Presentation 3 – Hannah Williams“Compliance with national guidelines for stroke in radiology”

15:05 Coffee

Session 2

15:35Outcomes of Kayne Putman’s 2012 Dermatology MSc Dissertation Prof. Alex Anstey – Director, R&D

15:40Presentation 4 – Harriet Jones“Patient flow through hospital-based therapies for psoriasis at ABHB”

16:05

Presentation 5 – Bradley Hardy“Development of a model to simulate sample-flow through the Biochemistry Laboratory in ABHB”

16:30Summing up & CloseDr Paul Buss, Interim Medical Director - ABHB

Outcomes and sustainability

Extract from email to students from Dr Julie Vile:

“The buzz you created at the event was something rarely seen at the NHS and I've hardly been able to get any work done this morning, due to the large number of people coming in the office praising your work which has really helped to raise the profile of the Modelling Unit within our health board.”

Outcomes and sustainability

Quote from Dr Danny Antebi

Director of ABCi (Aneurin Bevan Continuous Improvement):

“ Having seen some of the projects the mathematicians have been working on, senior managers in Aneurin Bevan University Health Board are becoming more and more convinced of the value of this approach. In my view we can’t manage increasingly complex systems, be they in health or otherwise, without modelling as an integral part of our design and analysis.”

Outcomes and sustainability

Modelling patient flow in ED to better understand demand management strategies – Elizabeth Allkins

Built a solid foundation for future research and the model is to be used to explore future scenarios

Assessing the impact of an ageing population and the effects of frailty programmes on RGH – Yiwen Fu

Recommended that a frailty team be placed within ED and a pilot is now underway

Questions?

www.cf.ac.uk/maths/research/researchgroups/ opresearch/healthcare

http://www.wales.nhs.uk/sitesplus/866/page/69767

Follow us on twitter @abciab

Email: Julie.Vile@wales.nhs.uk

Compliance with National Guidelines for stroke in radiology – Hannah Williams

The model identified a significant increase in compliance with revised guidelines and proposed changes to the initial plan for extended working hours

Modelling the provision of phototherapy services for dermatology clinics – Harriet Jones

The tool is to be further explored and recommendations on the location of future psoriasis centres are to be considered in South Wales Plan

Simulating the automated clinical biochemistry track system at RGH – Bradley Hardy

Identified reductions in cost and staff workload by removing/replacing analysers which are being considered for implementation

Other Masters Projects