Unscheduled care - The Challenges and Opportunities in Radiology CUH Trish Murphy Acting RSM1

What is Unscheduled Care Unscheduled care can be defined as health and/or social care which cannot reasonably be foreseen or planned in advance of contact with the relevant professional. It follows that such demand can occur any time and that services to meet this demand must be available 24 hours a day seven days a week. Improving the patient pathway through the Emergency Department for either subsequent admission or discharge is the most important challenge for the Hospital and requires collective commitment from all medical, surgical and diagnostic services.

Challenges Capacity issues in the Radiology Department Combining Scheduled & Unscheduled patients Overreliance on diagnostic tests by Clinicians Patient expectations to obtain diagnostics & TAT 24/7 service demands Changing demographics /patient profile ( Bed patients & co morbidities ) Recruitment & Retention of staff Resources from Management Justification , Triage & Prioritising of patients ( Transposition of the BSS September 2018 ) Support for Role advancement from Clinicians & Management Technological advances & CPD support Work life balance for overburdened staff

Capacity & Process

CUH CAMPUS

The hospital Campus

Floor Plan of CUH X-ray Main Block

Campus Diagnostic Activity 2017

Modality Activity 2017

Challenges Capacity issues in the Radiology Department Overreliance on diagnostic tests by Clinicians Patient expectations to obtain diagnostics & TAT 24/7 service demands Changing demographics /patient profile ( Bed patients & co morbidities ) Recruitment & Retention of staff Resources from Management Justification , Triage & Prioritising of patients ( Transposition of the BSS September 2018 ) Support for Role advancement from Clinicians & Management Technological advances & CPD support Work life balance for overburdened staff

Opportunities Project Flow Diagnostic Dependant Discharge (DDD) GP Liaison Nurse Dedicated CT & Ultrasound slots (AMAU & MSSU) Lean Management Culture Policy Procedure & Guideline (PPG) Teaching Hospital and student placement structure MSC Graduate Radiography Programme in UCC Audit & Review Process

What is Project Flow ? Project Flow aims to clearly identify the processes and systems that are required for safe, timely and effective delivery of care to the people that enter the hospital site. It includes looking more in depth at : Each patient’s required length of stay, Planning for each patient’s individual discharge, looking at weekday and weekend demand, linking with integrated care programmes in primary and community care services, A visual display of data in the hospital

Priorities Ward whiteboards Communication Patients in the hospital >14 days Non admitted patient experience time (PET) Weekend discharges Integrated care projects Cit opat etc dc handout

PF 18 Objectives Patient Safety Admission avoidance D2A Over 75 pathway Stranded Patient Weekend discharges System Re-design Data Acute Floor True Community Integration Navigational Hub

Project Flow 18 CUH

Team Based Approach

Opportunities Project Flow Diagnostic Dependant Discharge (DDD) GP Liaison Nurse Dedicated CT & Ultrasound slots (AMAU & MSSU) Lean Management Culture Policy Procedure & Guideline (PPG) Teaching Hospital and student placement structure MSC Graduate Radiography Programme in UCC Audit & Review Process

Cultural Change