Emergency Department Progress Report for Health Scrutiny Senior - - PDF document

Emergency Department

Progress Report for Health Scrutiny 27 June 2012

Chris Holt – Deputy Chief Operating Officer Dr Bob Coupe – Clinical Lead for Emergency Medicine

Introduction

• Senior Emergency Medicine Clinicians
• Middle Grade Doctors
• Nurse Staffing
• Patient Experience

Senior Emergency Medicine Clinicians

Criteria: 5 Substantive Senior Emergency Medicine Clinicians (or confirmed start dates)

– Dr Terri Bentley, on Specialist Register, commenced 1st December 2008, – Appointed as Clinical Lead March 2012 – Dr Bob Coupe, not currently on Specialist Register, commenced 26th January 2012 – Appointed as Clinical Lead March 2012 – Dr Rebecca Race, on Specialist Register, commenced 31st January 2012 – Dr Dilip Da-Cruz, on Specialist Register, commenced 15th February 2012 – Dr Venkat Kodamanchali, Middle Grade Specialty Doctor, Acting Consultant, commenced August 2010 (as MGSD 16th October 1996) – One vacant post out to advert, closing date 22 June. 2 applicants shortlisting taking place potential date for interview 19th July

Middle Grade Doctors

Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least 5 substantive and the remainder on fixed term contracts

Currently 4 Substantive Middle Grade Doctors:

• Dr Anca Angelescu, commenced MSFT 5/10/10
• Dr Mariel Bruzzo, commenced MSFT 6/12/10
• Dr Satya Khare, commenced MSFT 5/12/11
• Dr Muhammad Nagori, commenced MSFT 21/3/12
• All permanent appointments

Middle Grade Doctors

Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least 5 substantive and the remainder on fixed term contracts

Current 4 Appointed Middle Grade Doctors to join: – Dr Musunuru appointed May 2012 commences 1st November 2012 – Dr Zarroug appointed May 2012 awaiting restricted work permit (currently

• utside the UK)

– Dr Thakur appointed March 2012 awaiting restricted work permit (currently working in UK) – Dr Ya contractual negotiations being finalised (currently working in the UK on a restricted work permit) – All permanent appointments

Middle Grade Doctors

Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least 5 substantive and the remainder on fixed term contracts Current Long Term Agency Locum Middle Grade Doctors :

– 3 Long term agency locums all on 6 month contracts – Dr Hamzat: working with MSFT since September 2011 – Dr Iqbal: working within MSFT since December 2011 – Dr Yasin: working with MSFT since December 2011

Middle Grade Doctors

Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least 5 substantive and the remainder on fixed term contracts

Jun’12 Oct’12 Appointed 4 Permanent 4 8 Long term locums 3 1 TOTAL IN POST 7 9 Overview of Middle Grade Doctors

Middle Grade Doctors

Criteria: All Middle Grade Doctors to be suitably qualified in Advanced Life Support, Advanced Paediatric Life Support (100% qualified) and Advanced Trauma Life Support (min 3 qualified with remainder with dates booked)

Middle Grade ALS APLS / EPLS ATLS

Trust MG 1 Passed Passed Passed Trust MG 2 Passed Passed Passed Trust MG 2 Passed Passed Passed Trust MG 2 Passed Booked 27/28 Sept‘12 Passed Locum 1 Passed To be booked Passed Locum 2 Passed To be booked Passed Locum 3 Passed To be booked Complete Jun’12

Middle Grade Doctors

Criteria: All Middle Grade Doctors assessed (internal work based assessment) as competent to manage the department at night

• Teaching programme continues every week in relation to clinical

competencies

• All will be assessed with an Observed Skills Clinical Examination

June ’12.

• All clinical competencies to be signed off by the Consultants by 17

July.

• Ongoing observation and shop floor assessment to confirm their

competency to manage the dept overnight

• Shop floor management assessment of substantive and locum

middle grade doctors to be completed by mid-late July

Senior Nurse Staffing

Criteria: 1 WTE appointment of Emergency Care Matron 4.4 WTE appointment of Band 7 Nurses in post

• Matron attended staff induction in June and will start in the

department on 2nd July

• 4.4 WTE Band 7 nurses have been appointed – 1.6 WTE acting up

posts on a temporary basis – all will be in post July 2012

Nurse Staffing

Criteria: Nursing workforce to be at 90% establishment

• Overall nursing workforce at 93.20% as of June 2012
• 3 Staff Nurses commenced in June
• 1 Staff Nurses due to commence in July and another in October
• Interviews for Band 5 Staff Nurses on 5th and 6th July
• Based on recent recruitment and recent staff turnover the

predicted establishment will be at 90% therefore if suitable candidates are identified in July interviews they will be recruited into Band 5 posts

Nurse Staffing

• Establishment is 56.30 WTE across Trained and HCSW workforce
• Bespoke recruitment and induction programme in place

Jun’12 Oct’12

WTE % WTE %

In Post 52.47 93.20% 56.30 100% Appointed 2.6 4.6% Total 55.07 97.8% 56.30 100%

Overview of Nursing Workforce

Nurse Staffing

• The table below shows the A&E turnover rates for trained nursing staff

between August 2011 and April 2012

• ~30% of the workforce will have been replaced by Oct 2012

Month In Post Leavers Headcount WTE H/Count WTE Turnover % Aug’11 50 43.94 1 0.96 2.00% Nov’11 49 42.48 1 1.00 2.04% Dec’11 46 40.08 3 2.52 6.52% Jan’12 45 39.08 1 1.00 2.22% Feb’12 44 38.29 1 0.80 2.27% Mar’12 44 38.29 1 1.00 2.27% Apr’12 40 34.36 3 3.00 7.50% May’12 47 39.56 1 .60 2.12% June’12 50 41.96 2 1.6 4% July’12 50 41.96 1 1 2% Oct’12 51 45.19 TOTAL 51 15 ~30%

Nurse Capabilities and Training

• Criteria: Nurses’ competencies to be

monitored

Patient Experience

Patient Experience Attendances since closure

Date Attendance Breach %

1st Dec’10 to 1st May’11 21,808 4790 78.04 1st Dec’11 to 1st May’12 18,013 2025 88.76 Diff Down 3,795 Down 2,765

MSFT Attendance Profile

100 200 300 400 500 600 700 800 900 1000 1100 1200 9/10/2011 16/10/2011 23/10/2011 30/10/2011 6/11/2011 13/11/2011 20/11/2011 27/11/2011 4/12/2011 11/12/2011 18/12/2011 25/12/2011 1/1/2012 8/1/2012 15/1/2012 22/1/2012 29/1/2012 5/2/2012 12/2/2012 19/2/2012 26/2/2012 4/3/2012 11/3/2012 18/3/2012 25/3/2012 1/4/2012 8/4/2012 15/4/2012 22/4/2012 29/4/2012 6/5/2012 Attendances Week Ending

Total A&E Attendances versus Major Attendances between 3rd October 2011 and 6th May 2012

Total Attendances Major Attendances

Drop in attendances from OOH’s closure predominantly in Minors stream

OOH’s closure of A&E

• No. of majors patients remained static

despite closure overnight for 10 hours

MSFT Attendance Profile

• Attendance split since the closure indicates 55%

majors v 45% minors

• National patient mix is ~25% majors v 75% minors,

meaning the % number of breaches on a complex case mix is encouraging

• We are also experiencing the same number of

majors previously seen within a 24hr period in 14 hours

MSFT Performance

Quarter Month / Week Attends Breaches % Q4 11/12 Jan’12 3545 759 78.39% Feb’12 3402 610 82.07% Mar’12 3955 155 96.08% Q4’12 Q1 12/13 Apr’12 3635 176 95.16% May’12 4029 323 91.98% June’12 (to date) 04/06 878 46 94.76% 11/06 958 28 97.08% 18/06 918 34 96.30% Q1’12 to date 3248 138 95.75%

Criteria: Achievement of 4hr access target for 95% of patient attendances

70.0 75.0 80.0 85.0 90.0 95.0 100.0 %

A&E 4hr Wait Performance

National Average (%) MSFT (%) BURTON (%) UHNS (%)

MSFT Performance

MSFT performance consistently above national average since March’12

Hospital Flow / Discharges

Criteria: 30% of all daily discharges from medical wards by 11am

2 4 6 8 10 12 14 16 N

• .
• f

P a t i e n t s

• No. of Patients Discharged

Hospital Flow / Discharges -

Criteria: Weekend discharges to be 60% of average weekly discharges

Target = 15 Ward Based patients

Long Stay Patients

Criteria: To decrease the No. of Long Stay patients to <50

5 10 15 20 25 30 35 40 45 20 40 60 80 100 120 140 07/02/2011 14/02/2011 21/02/2011 14/03/2011 21/03/2011 08/04/2011 14/04/2011 21/04/2011 03/05/2011 11/05/2011 12/05/2011 17/05/2011 18/05/2011 25/05/2011 31/05/2011 16/06/2011 21/06/2011 29/06/2011 06/07/2011 14/07/2011 27/07/2011 03/08/2011 10/08/2011 17/08/2011 24/08/2011 31/08/2011 07/09/2011 14/09/2011 20/09/2011 28/09/2011 05/10/2011 12/10/2011 19/10/2011 26/10/2011 02/11/2011 09/11/2011 16/11/2011 23/11/2011 30/11/2011 07/12/2011 14/12/2011 21/12/2011 04/01/2012 11/01/2012 18/01/2012 25/01/2012 01/02/2012 08/02/2012 15/02/2012 22/02/2012 29/02/2012 14/03/2012 21/03/2012 28/03/2012 04/04/2012 11/04/2012 18/04/2012 25/04/2012 09/05/2012 16/05/2012 23/05/2012 30/05/2012 07/06/2012 13/06/2012 Avg LOS (days) # of Patients Overall Summary

• No. of Patien

ts Average of LOS

Summary

• Overall good progress on

– recruitment of staff – competency development of staff – achievement of 4 hour emergency access target – development of a new team with aspirations to be high performing – Weekly performance review with acute care physicians around patient flow indicators

• Progress still to be made

– ED team need to consolidate their skills and new staff members need time to settle into the team – Downstream work streams need to gather pace and deliver on trajectories