1. Frailty Capacity Modelling in West Lothian Neil Pettinger / 21 April 2015

3. A&E

4. AssessmentA&E

5. WardsAssessmentA&E

6. HomecareWardsAssessmentA&E

7. How many? HomecareWardsAssessmentA&E

8. How long? How many? HomecareWardsAssessmentA&E

9. How full? How long? How many? HomecareWardsAssessmentA&E

10. How full? How long? How many? HomecareWardsAssessmentA&E St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

11. How full? How long? How many? HomecareWardsAssessmentA&E St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014

12. How full? How long? How many? HomecareWardsAssessmentA&E 148 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

13. How full? How long? How many? HomecareWardsAssessmentA&E 151 minutes 148 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

14. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 148 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

15. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 148 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

16. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 148 attendances 29 hours St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

17. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 148 attendances 29 hours 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). This to fit into a bed complement of 36 + an element of Ward 22 (PAA)

18. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 26 admissions 148 attendances 29 hours 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

19. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

20. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 157 patients 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

21. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014: Boarding Levels

22. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 1,700 service users 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 157 patients 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

23. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 1,700 service users 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 75 minutes 157 patients 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

24. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 1,700 service users 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 75 minutes 157 patients 33 patients 2,125 hours St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

25. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 1,700 service users 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 75 minutes 157 patients 33 patients 2,125 hours St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22) Calendar Year 2014 / Four-hour compliance: 94.6%

26. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014: Boarding Levels

27. How full? How long? How many? Post AcuteWardsAssessmentA&E St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

28. How full? How long? How many? Post AcuteWardsAssessmentA&E 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

29. How full? How long? How many? Post AcuteWardsAssessmentA&E 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

30. How full? How long? How many? Post AcuteWardsAssessmentA&E 168 minutes 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

31. How full? How long? How many? Post AcuteWardsAssessmentA&E 168 minutes 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 138 minutes 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

32. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 138 minutes 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

33. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

34. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

35. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

36. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances 30 hours St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

37. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances 30 hours St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances 29 hours “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

38. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances 29 hours “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

39. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 151 attendances 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

40. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 26 admissions 142 attendances 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

41. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 25 admissions 26 admissions 142 attendances 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

42. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 6.3 days 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 25 admissions 26 admissions 142 attendances 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

43. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 6.3 days 30 hours 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 25 admissions 26 admissions 142 attendances 6.2 days 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

44. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 6.3 days 30 hours 160 patients 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 25 admissions 26 admissions 142 attendances 6.2 days 29 hours 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

45. How full? How long? How many? Post AcuteWardsAssessmentA&E 18 patients 168 minutes 27 admissions 27 admissions 151 attendances 6.3 days 30 hours 160 patients 34 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST How full? How long? How many? Post AcuteWardsAssessmentA&E 14 patients 138 minutes 25 admissions 26 admissions 142 attendances 6.2 days 29 hours 155 patients 32 patients “Worst” 91 days of 2014 (88% compliance)“Best” 91 days of 2014 (99% compliance)

46. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, calendar year 2014

47. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, 91 good days in calendar year 2014

48. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, 91 bad days in calendar year 2014

49. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, good & bad days, calendar year 2014

50. How full? How long? How many? HomecareWardsAssessmentA&E 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number. STEP 1: Better performance against the four-hour target

51. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number. How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day… STEP 1: Better performance against the four-hour target

52. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 6.0 days 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number. How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day… How full? can be derived as: 155 ÷ 26 = 5.96 (which I’ve rounded up to 6.0 days for the purposes of the grid) STEP 1: Better performance against the four-hour target

53. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 6.0 days 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number. How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day… How full? can be derived as: 155 ÷ 26 = 5.96 (which I’ve rounded up to 6.0 days for the purposes of the grid) Now let’s remind ourselves of what the actual calendar year 2014 figures were for the third – blue – column… STEP 1: Better performance against the four-hour target

54. How full? How long? How many? HomecareWardsAssessmentA&E 15 patients 151 minutes 26 admissions 26 admissions 148 attendances 6.1 days 29 hours 157 patients 33 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day). Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time). Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time. This to fit into a bed complement of 36 + an element of Ward 22 (PAA) This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22) STEP 1: Better performance against the four-hour target

55. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 6.0 days 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes This difference between 6.1 days and 6.0 days in the average length of stay for the downstream medical wards seems very small indeed. But it’s worth bearing in mind that it’s just less than 2 hours 30 minutes, and that in order to achieve this reduction, we’d have to reduce everybody’s length of stay by 2.5 hours. Or the equivalent. We’d need to reduce the number of occupied bed days per year by 950 in order to achieve this level of improvement (which would not only enable improved four-hour performance but would also – probably – enable a reduction in length of stay in Assessment that would make it less full and which – in turn – would allow the four-hour target in A&E to be met more frequently). STEP 1: Better performance against the four-hour target

56. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 6.0 days 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes This “ought-to-be” number of 155 includes patients who are occupying beds in the “wrong” wards. Let’s take a closer look at the boarding that was happening in 2014 in the four main wards that seemed to be “lending” the most amount of beds to Medicine… STEP 2: Can we reduce the amount of boarding?

57. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes Ward 12… STEP 2: Can we reduce the amount of boarding?

58. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes Ward 14… STEP 2: Can we reduce the amount of boarding?

59. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes Ward 15… (which looks more like a Winter Ward) STEP 2: Can we reduce the amount of boarding?

60. St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes Ward 18… STEP 2: Can we reduce the amount of boarding?

61. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 6.0 days 155 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes What boarding means is that – on average – about 15 beds per day of the 155 generated altogether by medical patients are occupied by boarders. So if we wanted to achieve 98% four-hour performance and have a situation where there were no boarders, we’d need the 155 figure to reduce by 15 to 140. (Except that 140 beds full on average out of a bed complement of 142 seems a bit on the high side – occupancy-wise: 98.6%. Whereas an occupancy of 137/142 (96.5%) (one empty bed in each of the five wards) seems more reasonable.) Let’s see what would need to happen for the current ;levels of activity to fit into an envelope of 142 at 96.5% occupancy… STEP 2: Can we reduce the amount of boarding?

62. How full? How long? How many? HomecareWardsAssessmentA&E 26 admissions 5.3 days 137 patients St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS Calendar Year 2014 Notes Using the same arithmetical logic that we applied before: 137 ÷ 26 = 5.27 (Rounded to 5.3 in the grid) This shows us what the average length of ward stay would need to be in the downstream medical wards if current levels of activity were to be accommodated without the need for boarding. It assumes that an average percentage bed occupancy of 96.5% is consistent with good four-hour performance. It’s important to bear in mind two things here. One is that the number of ward stays will reduce if boarding is eliminated (because the 2014 figure of 26 per day includes boarding ward-to-ward moves. The other is that it is likely that a reduction in boarding will of itself likely generate a reduction in length of stay (because we know that boarding is associated with longer length of stay) STEP 2: Can we reduce the amount of boarding?