NDHB Hospital At A Glance ‘HaaG’ Mark Goodman Hospital Coordination Unit Nurse Manager

Hospital at a Glance Screen (HaaG) A Variance Response Management tool to signal when patient and staff safety may be at risk due to a mismatch between Demand Clinical time needed to deliver care to patients, based upon acuity & Capacity Clinical hours (staff & skills, resources available to deliver care)

Hospital at a Glance Screen will: Show a picture of the current status of the Hospital at a Glance. Initiate discussions and signal the need to employ “Variance Response Management Plans” Identify need & availability to guide the sharing of staff to support other areas who may be dealing with significant demand capacity mismatch.

Hospital at a Glance Screen ‘Bar Graph’ of (physical) capacity of each area. Shows physical beds and current utilisation. Variance Indicator field below each areas bar Includes agreed area specific indicators that are designed to be an alerting system Can’t look at one without the other.

Care Capacity Variance A selection of specific indicators that measure the pressure of resource demands and deficits of the ward/units. Each area has a combination of common and unique indicators, including;  Staffing issues (skill mix, hours to care, etc).  Patient acuity  Churn  Professional judgement. A ‘real time’ holistic view

What happens with the information ‘In the moment’ Each time the ward Care Capacity Variance Indicator is saved it will: Update the Hospital at a Glance screen. Time stamp the change. Record what indicators were selected. Record what CCVB status was saved (colour).

Variance Response Management. Test Ward Variance Response Local After Hours Action Plan Mauve ( Extra capacity) Green ( Capacity matches demand ) Yellow ( Early variance) Orange ( Significant care capacity deficit) Red ( Critical care capacity deficit). Coordinator determines plan for the shift and communicates with Duty Manager Expedite discharges: Review patient management plans. Offer staff for period available (e.g. 1 hour, 2 hour, 4 hour, meal relief, full shift). Staff maybe directed to area of greater variance Review staffing for next 24hrs. Pull patients in from other areas (e.g. outliers or ED) If staff not required, consider offering annual leave or time in lieu (if owing). Consider quality improvement activities Coordinator determines plan for the shift and communicates with Duty Manager Expedite discharges: Review EDD for patients’ expected to discharge in next 24hrs. Review patient management plans. Escalate to medical team any patients not seen in last 24hrs. Staff maybe directed to area of greater variance in consultation with Duty Manager. Review staffing for next 24hrs. Consider capacity to ‘pull’ patients in from other areas (e.g. outliers or ED) Consider quality improvement activities Ensure appropriate timely referrals to Allied Health Coordinator determines plan for the staffing and shift and communicates with Duty Manager. Discuss assistance from other areas that have capacity Receive assistance from other units as available – use SMART 5’s as appropriate Coordinator remains on the unit. Expedite discharges: Review patient management plans. Escalate to medical team any patients potentially for discharge Repatriation of patients to other facilities/units. Reassess status in 1 hour. Review staffing for next 24hrs. As per Yellow plus: Notifies Duty Manager and requests specific resource eg additional staff or admit stop. DNM considers use of staff from areas that are ‘green’ DNM/Coordinator consider calling in staff,overtime, and/or extended shifts Consider ‘admit stop’ till situation resolved Ensure medical team are aware of status. Reassess status in 1 hour Put agreed care rationing measures in place As per Orange plus: Mandatory reporting to Duty Manager and,Service Manager. DNM/Coord take on floor co- ordination role as appropriate. Implement “admit stop’ Put ‘life and limb’, agreed care rationing measures in place including rounding. Reassess status in 30 minutes If > 1hr notify GM on call

Reporting available includes ; Each Unit/Wards status over time. A record of what indicators were saved and who changed them. What happens with the information ‘longer term’

Variance Response Definitions Mauve (Extra capacity) Green (Capacity matches demand ) Yellow (Early variance) Orange (Significant care capacity deficit) Red (Critical care capacity deficit). We have the resource to assist other areas. Not necessarily a whole shift. All good. Able to receive patients Business as usual We have stressors but are OK unless we request assistance. Staff may miss breaks. Please feel free to offer assistance – we may accept New patients may need to be accompanied by resource Usually will be managed locally. Patient care may be compromised. Staff prioritise care leading to care rationing Staff may be working overtime and missing breaks. Need additional resource/assistance to remedy. UNACCEPTABLE Needs fixing now. ?major incident

Ongoing work Reporting of HaaG data Improving HaaG data Reviewing indicators and plans Local data councls

Challenges remaining Capturing the Hospital status Representing Allied Health Engaging medical colleagues Embedding the system into culture