1. CHALLENGES FOR ACUTE SURGERY
Elective
Acute

2. Improving Elective Practice Improving Acute Practice
Generic Models of Care
Improving Elective Practice
Pre-admission Assessment
Day Surgery
Day of Surgery admissions
Discharge planning
2010
Improving Acute Practice
Separate stream
Early access to Senior Decision Makers
Acute Surgical Assessment Units
2013
Common goals
Peri-operative Governance
TPOT
Designated beds and theatres
10/02/2016

3. NCP / HIU / HIPE / OpenApp -> NQAIS
Surgery Discharges between 2010 and 2014 (including Acute and Elective admissions for surgery or surgical care)
National figures
Acute & Elective discharges from Model 4, 3 & 2 hospitals excluding Maternity, hospice and rehabilitation type hospitals
10/02/2016
NCP / HIU / HIPE / OpenApp -> NQAIS 3

4. CANCEL PLANNED ADMISSIONS
WAITING LISTS
TROLLIES ↑
CANCEL PLANNED ADMISSIONS
10/02/2016

5. 10/02/2016

6. Hospital overload EXCESS UNPLANNED CARE DELAYED DISCHARGES
Poor, untimely planning
Inadequate Fair Deal
Inadequate Community
Care
Increasing Numbers
Increasing Age,
Chronic Diseases &
Complexity
Inadequate or unused 1⁰ Care
Inadequate access to
diagnostics
Inadequate Resource
Beds
Diagnostics
Theatres
Workforce
Inefficient Flow
Process
Performance
Integration
IN HOUSE
CONSTRAINTS
PLANNED CARE
10/02/2016

7. National HIPE discharges in 2014
AvLOS =
5.16 days
10/02/2016

8. Hospital referral / Transfer
GP referral to A*AU – under criteria guidance
AMAU/ASAU
Senior Decision maker
Hospital referral / Transfer
SSU GP
AEC
Senior Decision maker
AEC
Treat/ Follow up/Discharge ?
Discharge path/GP
TRIAGE
SELF ED
CDU/RATU
Minor Injuries
RESUS
AMBULANCE
Triage is not necessary if there is enough staff to meet individual needs. It is necessary when this is not the case and patients require care pathways.
Each pathway requiring different skills, having different demands and working a different speeds.
Two important roles – to define severity of illness and direct patients to appropriate care setting.
Structures are dependant on the size of hospital.
Inpatient
Ward
(observer / recover)
Inpatient
Senior Decision maker
Out Patients
Theatre
ACUTE FLOOR - PATHWAYS TO ADMISSION AVOIDANCE OR EARLY DISCHARGE

9. Rapid transfer from Triage or direct referral from Primary Care
ASAU advantages
Rapid transfer from Triage or direct referral from Primary Care
Surgical cases are in one area. ‘Safari’ ward rounds avoided.
Quick prioritisation by experienced, focussed staff.
Maximises ambulatory emergency care; nurse-led early discharges .
Early imaging and diagnostics
Supports E D waiting time targets.
More rapid direct access to theatre
Shorter AvLOS & more positive patient experience..
Early Senior Decision Maker (Consultant) assessment.
Model 3 but ? Model 4
10/02/2016

10. Managing Inpatient Flow and Performance
Maximise ambulatory care
Sept ’14
– Aug’ 15
Flow management
Complex support needs – hospital and community based
10/02/2016

11. Managing Inpatient Flow and Performance
Patient information Hubs
Rounding discipline
Ward Cohorting
Discharge by 11
Pre-admission assessment
DOSA
Cancelations
Theatre management
Weekend working
Whole system patient flow hubs/Demand and Capacity Management
Ward rounding discipline, Ward Cohorting, Discharge by 11
Pre-admission assessment, DOSA, Theatre management
Weekend working
10/02/2016

12. GENERAL PRACTICE EMERGENCY MEDICINE OLDER PERSONS COMMUNITY CARE
SURGERY
Model of
Care
Model of
Care
Model of
Care
Model of
Care
INTEGRATED CARE (COMMUNICATION and UNDERSTANDING) THAT SPANS ORGANISATIONAL BOUNDARIES
Ultimately focused on the patient
10/02/2016