The NHS continues to make headline news as it struggles to meet demands amidst the realisation that extra funding will not be forthcoming. Whilst the whole system is under pressure it is perhaps felt most profoundly in urgent care, more specifically accident and emergency departments of acute hospitals. However, the demand for urgent care arriving at a hospital’s front door and the patient journey from there on, creates and compounds difficulties in respect of maintaining a good flow throughout the hospital system right up to the discharge process.
As part of Open Forum Events’ health and social care portfolio, this year’s annual urgent care conference Urgent Care: Improving Patient Flow will focus on measures that can alleviate the congestion and successfully restore dynamic flow.
The most recent Accident and Emergency Statistics publication shows that there has been a significant rise in the number of people attending A and E departments, despite constant efforts to reform the system and relieve some of the pressures by signposting to other areas of healthcare provision. The increase in footfall has had the knock-on effect of patients having to wait longer to be seen. This is the point at which good patient flow becomes compromised, as illustrated by a fivefold increase, over the last five years, in the number of patients waiting longer than 4 hours to be admitted as inpatients from the A and E Department.
Good flow requires space and in the case of a hospital this means beds. Over recent years bed occupancy has increased and coupled with an increase in length of stay as a possible consequence, the speed at which patients can be assessed, treated and discharged is delayed resulting in gridlock. Delayed transfer of care at the discharge stage further curtails bed capacity, as those medically fit to be discharged cannot leave the hospital due to a lack of an onward care package being in place or the absence of other necessary provision.
Some of the answers in overcoming the challenges in patient throughput lie outside the hospital environment. Reducing the attendances to A and E and expediting timely discharge can be greatly influenced with services offered by primary, community and social care providers.
The Urgent Care: Improving Patient Flow conference agenda has been developed to explore the current patient flow trends within the hospital urgent care system. Delegates will gain a greater understanding of how the problems occur from the start of the process, with the patient having attended the A & E department, through to the discharge process, returning back into the community and home. Our line-up of expert speakers will provide insight, opinion and stimulate debate as to how to relieve the burden on hospitals and reduce the pressures of compromised patient flow. We will showcase a number of initiatives and examples of best practice from throughout the health and social care system and there will be ample opportunity for interactive discussion and networking amongst fellow professionals and peers.
The arrival of Spring heralded another announcement by Simon Stevens as he revealed new proposals to safeguard the future of the NHS service. For an overwrought urgent care system, there are developments that may offer some respite to the overreaching demand. The current pressures permeate through the whole fabric of the hospital as more people attend A and E, more people need to admitted and more people are subject to delayed transfer of care even though they are medically fit for discharge. This all amounts to sluggish patient flow and a congested system.
The latest figures published reveal that in 2016 there were on average 2,210 more attendances to A and E units every day than in 2015 representing a 5.5% increase. This inevitably has resulted in patients having to wait longer for treatment. 16.2% of people spent more than four hours in major A and E departments, a rise of 4.8 % over five years. These figures explain the start of how the system begins to snarl up and is borne out by the fact that in 2016, on average each day, 1,477 patients waited 4+ hours for admission to hospital via A and E. Five years previously the figure was 270 a day. The UK’s changing demographics also has a part to play. People aged over 80 have the highest rates of A&E attendance and this may also explain an increase in admissions from A and E. In December 2016, a new monthly record high of 11,953 emergency admissions per day via A and E was set. This was 3.4% higher than December 2015.
To alleviate some of the pressure on A and E departments by reducing attendances and further up the system free up acute bed occupancy, thus improving flow, Sir Stevens proposals include:
Improving patient flow through a hospital requires beds. The more people attending A and E, the more people being admitted and the more medically fit for discharge patients occupying beds, the more the pathway of care is slowed down. A report by the National Audit Office estimates that 2.7 million hospital bed days are occupied by older patients no longer in need of acute treatment. Hospitals should run at 85% bed occupancy for safety reasons. This past winter 130 out of 179 hospital trusts reported rates exceeding this for general hospital beds.
Although system improvement within the hospital itself is always possible, many of the solutions to improving patient flow can be found away from the hospital setting. Ambulatory care, primary care, community care and social care all can have a significant part to play at the start and end of the flow process by averting visits to A and E and facilitating timely discharge.
The Urgent Care: Improving Patient Flow conference will feature many innovative and practical examples of how the impacts of compromised patient flow can be mitigated and system improvement can be achieved.
With more people arriving at A and E’s reception desk, resulting in more people being admitted, more people are waiting to be seen and more are waiting for a hospital bed. Meanwhile, at the other end of the patient journey, acute beds are being occupied by patients medically fit for discharge but other external factors are delaying them from returning home. The result is gridlock. How can we get go with the flow and keep it moving?
A new pilot scheme has been introduced by the North East Ambulance Service (NEAS) and aims to reduce the load on Sunderland’s A&E departments by more than 1,825 attendances every year. The Paramedic Pathfinder will train NEAS ambulance clinicians working in the area to use a ground-breaking clinical triage tool, which helps them to make extremely accurate face-to-face patient assessments and confidently choose the most appropriate place for treatment.
In this session Samantha Riley will provide an overview of the recently launched Emergency Flow Improvement Tool : an online resource, which presents a range of indicators that illustrate flow through a trust from arrival to discharge. This flow tool is provided as an improvement aid rather than a performance tool; allowing Trusts and their stakeholders to visualise their data and prompt questions about where demand, pinch points and blocks are occurring in their system.
University Hospitals Coventry and Warwickshire NHS Trust is one of the UK's largest teaching Trusts, responsible for managing two major hospitals and over a million service users.
UHCW has worked with Nugensis to develop the Electronic Patient Flow Framework (ePFF) platform to deliver better patient outcomes.
The ePFF provides an integrated ‘at-a-glance’ view of patients at University Hospital. It utilises existing information sources to display an intuitive and entire patient package for the first time, from acuity to National Early Warning Scores to discharge planning, allowing staff to identify, understand and react quickly to issues in their ward and at trust level.
The SAFER patient flow bundle is a practical tool to reduce delays for patients in adult inpatient wards (excluding maternity). When followed consistently, length of stay reduces and patient flow and safety improves.
In this session Seamus McGirr will discuss the strategies and tactical arrangements needed to reduce harm from gaps in systems management. Using real information and predictive analyses, Seamus will illustrate how existing information can and is being used to align “real capacity” to treat with known patient flow. Seamus will show how demand is precisely predictable and outline the steps required to align care systems with population needs and behaviours.
Hospedia will be sharing a vision of Patient Flow and Digital Inclusion in hospitals in a truly unique way. Hospedia’s Patient Flow solution is already delivering significant benefits to the NHS. It works on the principle that patients need to be “pulled” through the Hospital with wards and teams working together with shared Visibility and Accountability – it’s not about managing beds, it’s about managing a complex. The solution is built with Nurses in mind that must be able to see at a glance the status of the patient, their journey and the ward the nurse is working on. Hospedia will also pose the question, “what would you do with 60,000 computers sat right at the bedside? What if you included the patient in their care and connect them to the process?
In 2013/14, City Hospital Sunderland was treating an average of 43 emergency patients a week as ambulatory. By 2015/16, that had risen to an average of 186 patients - up by more than 400%. This extraordinary performance is due to a whole- system approach to Ambulatory Emergency Care, which has been led by NHS Sunderland CCG. This case study will discuss the key aspects of Sunderland's approach.
So, you want to divert 25, 30 maybe even 40 percent of your footfall to a UCC so they never feature in the beds dilemma and you have heard that those clever people at St Elsewhere’s have a solution. All too often we think that because it worked there, it will work here. One size does not fit all and if we don’t understand the root cause of our own problems we will only be applying a plaster rather than finding a cure.
Delivering a Health and Well-Being Offer: The Oldham Experience. A case study on supporting A and E and the hospital discharge processes.
The development of a module toolkit designed to empower systems to understand their demand and support local improvements. National testing has identified themes and work is underway to develop flow kit guidance on these themes.
Focus has developed a new Hospital In-Reach Team called HIT. The aim of the team is to efficiently support the discharge of individuals from hospital who have an adult social care need. The team works with multi-disciplinary partners to identify individuals with needs who consent to social care support.
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