The Emergency Services Collaborative

1
The Emergency Services Collaborative

• Georgie Sullivan
• Associate Director

2
Aim of todays presentation

• Discuss the Emergency Services Collaborative
  Programme
• Outline the key changes and challenges to improve
  emergency care
• Highlight links between cardiology improvement
  and the ESC

3
Flow mayhem!
4
Warwick Report9 key findings

• Significant levels of demand for minors
• Demand for emergency care is predictable
• Reactive approach to demand with little planning
  or resources or skill mix
• Variation is the main problem - not volume
• Current processes are poor at coping with
  variation causing unnecessary delays

5
Warwick Report 9 key findings

• Process flows more helpful than clinical flows
• Capacity bottlenecks are often not recognised
• Many delays occur at the interface between
  different agencies/departments
• Performance reporting systems should focus on
  time-based measures

6
Aims of the Emergency Services Collaborative

• Reduce waits and delays and improve patient and
  carer experience of emergency care across the
  whole emergency system
• Support achievement of NHS Plan target

7
What do patients want?
8
Why a collaborative?

• More than 100 collaborative programmes world wide
  since 1996
• Clear aims and measures
• Focus on specific system of care
• Clear structure and time scales
• Focus on spreading existing knowledge
• Significant, sustainable results
• Involvement of frontline staff

9
Really why a Collaborative?
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The headlines...

• 200 sites 6 waves
• Whole System Change
• Emphasis on Clinician Leadership Executive
  Support
• Structured improvement methodology
• Test make changes measure share
• Transfer principles not solutions
• Patient focused
• Work within 4 clinically led project teams

11
Four key patient flows through Emergency Care
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What sort of changes are we seeing?

• Improved systems and processes
• Improved efficiency
• Improved planning
• Improved use of information
• New ways of working - flexibility
• New roles and responsibilities
• Improved partnership working
• Better patient and carer experience
• Improved working lives

13
MondayWithout See Treat
712
640
600
549
528
448
350
Journey Time (hrsmins)
336
332
224
127
112
000
1
4
7
10
13
16
19
22
25
28
31
34
37
40
43
46
49
52
55
58
61
64
67
70
73
76
79
82
85
88
91
94
97
100
103
Patient No
Journey Time
Median
Upper Process Limit
Lower Process Limit
14
MondayWith See Treat
Journey Time (hrsmins)
29
31
33
35
37
39
41
43
45
47
49
51
53
55
57
Patient No
Journey Time
Median
Upper Process Limit
Lower Process Limit
15
The revised contextfor the ESC

• Bed Management Improvement Programme
• Emergency Care Networks
• IPH
• Incentive action plans
• Refocused ESC
• Sustainability

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Where do we need to be?

• NHS Plan Target by December 2004
• 100 AE attendances seen, treated and
  transferred / discharged within 4 hours
• The Incentive scheme
• Average 94 1 March 2004 31 March 2004
• Average 95 1 April 2004 30 June 2004
• Average 96 1 July 2004 30 Sept 2004
• Average 97 1 Oct 2004 31 December 2004
• Average 98 1 Jan 2005 31 March 2005

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Key challenges

• Whole systems working
• Attendance and admission avoidance
• Rapid assessment and treatment
• Access to diagnostics
• Access to senior clinical decision makers
• Real time patient monitoring
• Access to beds
• Management of the acute episodes of care
• Staff development and training
• Integration of ESC work
• Sustainability

18
Working together?
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Royal Lancaster Infirmary
20
Furness General
21
Musgrove Park
22
Dewsbury District Hospital
23
Countess of Chester
24
Manor Hospital
25
Harrogate District Hospital
26
Poole General Hospital
27
The key challenge
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Over to you.
www.modern.nhs.uk/emergency georgie.sullivan_at_doh.
gsi.gov.uk 07879 475041