Our journey and experience to date Emergency care and streaming at Sherwood Forest Hospital NHS Foundation Trust Our journey and experience to date

Our journey Co-located A&E and Primary Care walk in service at Kings Mill Hospital Two entrances and two receptions – patient chose which service to attend Estates work – Single front door and reception Patient chose service to attend at reception Streaming protocols developed Joint led streaming – 20% of all activity streamed to Primary Care A&E led streaming – 23% of all activity streamed to Primary Care (30% of walk ins)

ED performance From the 5th worst to one of the top 4 hour performers in the country (against a backdrop of a 15% rise in attendances) From a CQC safety rating for A&E of ‘inadequate’ to ‘good’ and came out of special measures Admission conversion rate to a bed now 16-20% Reduction in time to triage < 15 minutes A&E performance April 2017 = 95.92%, May = 95.55%, June = 96.68%, July = 95.53%

Performance

Strengths Co-located primary care service A&E led streaming model Early senior input Ambulatory Emergency Care Unit (AECU) Admission not the safer option Only admit those who cannot be treated at home/in the community Do not admit for investigations Jointly developed streaming protocols Community input into A&E Pathways to primary care and community developed

Weaknesses Not compliant with the recommended Luton &Dunstable model as per NHSE guidance Commissioners had envisaged Primary led streaming model but unable to staff Change in Out Of Hours provider led to instability for period of time Challenges in aligning governance processes across two different organisations Victim of own success – build it and they will come!

Opportunities Further pathways to primary and community care to be added to the streaming protocols Expansion of AECU and associated activity Paediatric pathways yet to be explored Integrated discharge pathways via call for care (front door and back door) Mirror model at local Newark Urgent Treatment Centre

Threats NHSE mandating Luton and Dunstable model of streaming at the front door Continued development of community services and the Integrated Urgent Care agenda will reduce the pool of patients that can be streamed – balancing metrics required

Contacts For further information following this event please email: nshccg.bettertogether@nhs.net