Unscheduled Care Information Available Fiona MacKenzie Service Manager, ISD

Aim Find out more about the information held nationally and locally and how this can be used to gain a better understanding of how people interact with various unscheduled care services.

The Plan Overview of unscheduled care data/intelligence Discussion Feedback

Definition of Unscheduled Care Health/Social Care that cannot reasonably be foreseen or planned in advance of contact with relevant services…such demand can occur any time, and must be available 24/7. Unscheduled care is, by definition, urgent, with a need to take action at the time of contact with services.

Each Year across Scotland 1.6 m attendances at A&E 1.5 m calls to NHS 24 700k emergency and urgent calls to SAS 1m Out of hours contacts 24 m all primary care appointments (estimated 12/13) estimate for urgent?? 560k Emergency admissions

Some solutions for Scotland

6 Essential Actions to Improving Unscheduled Care Performance To achieve: Improve: By managing: Do these well: Triumvirate Management Clinical Leadership Escalation Safety, Flow Huddles Clinically Focused and Empowered Management Basic Building Blocks Bed Planning Toolkit Workforce Capacity Toolkit Performance Toolkit Hospital Capacity and Patient Flow Realignment Safe, person centred, effective care delivered to every patient, every time without unnecessary waits, delays and duplication Patient rather than Bed Management - Operational Performance Patient tracking through System Admission/ discharge prediction Balance capacity & demand Daily Dynamic Discharge Patient and Staff Experience Triage to appropriate assessment Flow through ED Access to Senior Decision Maker Access to Assessment/Diagnostics Medical and Surgical Processes arranged to Pull Patients from ED Smooth variation in services Surgical Emergency & Elective Services Access to Diagnostics /Intervention GP/OOH Support 7 Day Services Ensuring Patients are Cared for in their Own Homes Redirection / Know Who To Turn To Shift Emergency to Urgent Short stay assessment / Avoid admission Discharge when fit & ready

Basic Building Blocks – Hospital detailed understanding of the existing unscheduled care pathways meaningful data which improves understanding of demand at each stage of the patients pathway knowledge of demand to support realistic capacity planning to improve the quality of care and patient outcomes improved understanding of the cause-and-effect relationships in the system support management to identify the numbers associated with a ‘functioning system’ fuller engagement in utilising data for modelling transformation and service redesign and potential impacts in depth analysis to support business case for change

Pulling Together: Transforming Urgent Care for the People of Scotland Person-centred care requires reliable and accurate person-centred information, available at the right time and in the right place. The proposed Urgent Care Resource Hub model offers a potential opportunity to help coordinate and interpret information at area and locality levels – particularly in complex cases and those with enduring conditions

Unscheduled Care Services Primary Care In hours Pharmacy NHS 24 Primary Care Out of Hours SAS A&E Emergency admission Social Care Third sector e.g. Guardian Response Mental Health crisis teams

Provided by: Pharmacists Dr’s Nurses Health care assistants District Nurses Allied Health Professionals Paramedics Volunteers Carers Family / Friends The list goes on.....

Pharmacy & Unscheduled Care Existing data Minor Ailment Service Chronic Medication Prescribing in Mental Health All Prescribing activity – open data/dashboard Costs Antimicrobial prescribing Hospital Prescribing

Minor Ailments Service Just under 1 in 5 of the Scottish population are registered >2.1 million items were dispensed (2.2% of all items dispensed by community pharmacies in Scotland The cost of items dispensed = £5 million (total pharmacy cost >1bn) Paracetamol accounted for over 1 in 5 items dispensed Are enough people using the service?

Primary Care in hours Workforce information Locally data from GP systems eKIS, Anticipatory Care Plans Scottish Primary care Information Resource (SPIRE) bespoke questions which practices will opt into installations begin in NHS Greater Glasgow and Clyde, NHS Dumfries & Galloway and NHS Fife, Scotland-wide expected January 2017 Public Information Campaign materials are finalised.

Primary Care Out of Hours Locally data and reports from ADASTRA Nationally Patient data for each consultation from April 14 GP Practice Geography - Board/Local Authority/ Localities/Urban/Rural By diagnosis/condition – falls, frailty, LTCs, drugs, alcohol, mental health etc Time of day, day of week Deprivation Age/Gender

Boxplot showing number of PCEC consultations by day of week 1 Jan 15 - 30 Nov 15 – LUCS PCEC

25 most common diagnoses 25-44 years Apr – dec 14

NHS 24, SAS, A&E, Emergency Admissions, Mental Health & deaths Local engagement with Partners Nationally - Unscheduled Care Datamart Links an individuals journey(s) through unscheduled care services across Scotland Data available from 2011 From Dec16 Primary Care OOH included Complex!

Unscheduled Care UCD 159 patiens with a confirmed diagnosis of stroke and Stroke elicits a direct ambulance referal or a serious and urgent outcome at call handler level ie early in the patient journey. FAST (Facial droop, arm weakness, speech slurring time to phone 999

Used for Improving care – Stroke, chest pain Planning (e.g DCAQ) Understanding usage of unscheduled care by community (patients and clinicians) deprivation clinical condition – frailty, falls, chaotic lifestyles, asthma, injury, abdominal pain etc etc Age/gender

A&E Monthly and Weekly Patient level and aggregate Publications 4 hr wait standard Standard reports in BOXI e.g. Frequent attenders Injuries, Mental Health, Drug and Alcohol

practice X - rate of A&E attendance

System Watch – Community and Hospital Monitor Prediction (regression and holt winters) emergency admissions (up to 6 wks in advance) Beds occupied (does have planned admissions) Admission and Discharge data at patient level Presented at Board, Hospital and Medical, Surgical and Paediatrics NHS 24, SAS, HPS, A&E and deaths Stakeholders – Boards, HIS, SG – others? A ‘stay file’ produced – CIS type record – LOS Predictions available up to 6 weeks ahead for Emergency bed occupancy Emergency admissions Seasonal, weekday and holiday variation 95% confidence intervals (6 weeks) MAPE (mean absolute percentage error) on historical predictions Regression and holt winters

To summarise Lots of information and intelligence around unscheduled care Used both locally and nationally Could we be doing more ?

Any Questions? http://www.isdscotland.org/Health-Topics/Emergency-Care/

Questions How should LIST/ISD engage locally with Health, Social Care or Third sector to share unscheduled care intelligence? What else should either the ISD or LIST teams be doing with Unscheduled Care Data?   Is there anything we should stop doing?