Patient Flow A Bird’s Eye View

Without additional resource Bed Bureau Hospital @Home Western General Hospital Discharge Lounge GP’s Without additional resource Through communication and collaborative working By breaking down organisational and system barriers Lothian Unscheduled Care Service Social Work Royal Infirmary Edinburgh Transport Hub NHSL Patient Transport Discharge Hub Integrated Joint Boards Outpatients Departments Pharmacy St John’s Hospital Scottish Ambulance Service

PATIENT FLOW GP’s Flow Centre Royal Infirmary Edinburgh Discharge Hub Integrated Joint Boards Discharge Lounge Integrated Joint Boards Outpatients Departments Western General Hospital Lothian Unscheduled Care Service Scottish Ambulance Service Pharmacy Hospital @Home St John’s Hospital Hospital @Home Social Work Social Work PATIENT FLOW

Key Goals THE VISION Whole system approach Community based services General Practitioners Third Sector Alternative to admissions Scottish Ambulance Services Secondary Care Improve patient flow by breaking down boundaries Direct and manage flow from a bird’s eye view of services Early detection of pressures in the system Efficient use of current resource Gold Standard

Background Hospital sites working in silos Bed Bureau for GP admissions Transport Hub for transfers /discharges Arrival curve of patients late in the day Limited transport options for GPs Long delays waiting for ambulances No Lothian wide overview of flow No extra resources available

What we did Stakeholder events Development of steering board Integration of existing services SAS/H&SCP/THIRD SECTOR partnership Single point of contact for all urgent GP referrals Increased transport options Streamlined / created pathways Technological overview of Lothian wide patient flow in real time Early identification of pressure points

Outcomes Increasing alternatives to admission >100 patients per month treated in their own home 66% of patients now make their own way to hospital All GP urgent patients on Flow Centre vehicles wait <4 hours 32% patients who previously travelled by SAS emergency ambulance now arrive by FCV saving 380 ambulance days per year Patients arriving at hospital earlier in the day to hospital Expected patients lists for each site so they can plan for demand Flow Centre taking 9200 calls/ month with 95% of calls answered within 60 seconds

Future Further increase alternative to admissions Flatten the admission attendance curve 100% GP / IJB urgent referrals are admitted Improve overview of OOA urgent referrals and repatriations Joint working with 3rd sector Work to break down barriers between organisations

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