1. Governing Body Quality Update
Urgent Care and Patient Flow
May 2015

2. Contents
Updated performance and activity information
Trust and system actions to improve quality and performance

3. Current performance – 95% Standard
95% performance - WRH
13/14
14/15
15/16
YTD
89.5%
89.2%
74.9%
Worcestershire Royal Hospital
Performance in Apr / May 15 is much worse than in previous years.
Performance in previous years circa 90% YTD in Mid May. This year circa 75%.
Performance shows a similar pattern to the prior year, but at a lower level.

4. Current performance – 95% Standard
95% performance - WRH
95% performance - ALX
13/14
14/15
15/16
13/14
14/15
15/16
YTD
89.5%
89.2%
74.9%
YTD
85.0%
96.7%
88.3%
Worcestershire Royal Hospital
Performance in Apr / May 15 is much worse than in previous years.
Performance in previous years circa 90% YTD in Mid May. This year circa 75%.
Performance shows a similar pattern to the prior year, but at a lower level.
Alexandra Hospital
Performance down on last year, but improved on 13/14.
Similar pattern and recovery shown as in 13/14.
Performance significantly better than WRH.

5. Emergency Department Attendances
Number of A&E Attendances - WRH
Attendances
-9.4% / -2.6%
13/14
14/15
15/16
YTD
8871
9534
8636
Number of A&E Attendances – Patients >75 - WRH
Attendances
-5.9% / +7.9%
13/14
14/15
15/16
YTD
1230
1406
1323

6. Emergency Department Attendances
Number of A&E Attendances - WRH
Number of A&E Attendances - ALX
Attendances
+5.8% / +7.9%
13/14
14/15
15/16
YTD
7157
7299
7723
Attendances
-9.4% / -2.6%
13/14
14/15
15/16
YTD
8871
9534
8636
Number of A&E Attendances – Patients >75 - WRH
Number of A&E Attendances – Patients >75 - ALX
Attendances
+20.6% / +3.8%
13/14
14/15
15/16
YTD
994
856
1032
Attendances
-5.9% / +7.9%
13/14
14/15
15/16
YTD
1230
1406
1323

7. Emergency Admissions Number of Admissions - WRH
-9.7% / -9.2%
13/14
14/15
15/16
YTD
3856
3875
3500
Number of Admissions – Patients >75 - WRH
13/14
14/15
15/16
Admissions
-9.7% / +2.3%
YTD
912
1033
933

8. Emergency Admissions Number of Admissions - WRH
Number of Admissions - ALX
13/14
14/15
15/16
Admissions
-7.9% / -6.9%
YTD
2492
2520
2320
Admissions
-9.7% / -9.2%
13/14
14/15
15/16
YTD
3856
3875
3500
Number of Admissions – Patients >75 - WRH
Number of Admissions – Patients >75 - ALX
13/14
14/15
15/16
Admissions
+4.0% / -2.3%
YTD
684
642
668
13/14
14/15
15/16
Admissions
-9.7% / +2.3%
YTD
912
1033
933

9. PFC Discharges and DTOCs
Delayed Transfers of Care
Changes to reporting methodology in October 14 have made comparisons difficult.
Counting methodology in April 15 now compliant with the requirements of the Care Act.
DTOC - April ‘14 = 48, April ‘15 = 57.
DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better.

10. PFC Discharges and DTOCs
120
121 97 91
March 75
Feb 63
April 57 37 49 48 48 48 51 48 96 59 59 79 63 75 57
Delayed Transfers of Care
Changes to reporting methodology in October 14 have made comparisons difficult.
Counting methodology in April 15 now compliant with the requirements of the Care Act.
DTOC - April ‘14 = 48, April ‘15 = 57.
DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better.
PFC Discharges
(Not shown in chart) PFC discharges account for circa 15% of all acute discharges.
When PFC weekly discharges exceed 100, DTOC figures generally fall. When they are 90 or less DTOCs generally rise.
Improvement plan to get PFC discharges to circa 130 per week.

11. Trust and System Actions
The SRG has led the development of a system wide urgent care and patient flow plan.
Based on the numerous external reports, internal quality walkthroughs and recognised best practice.
Designed to prevent numerous, fragmented plans.
SRG to take lead in ensuring delivery.
Essential component is the Trust’s Patient Care Improvement Plan (PCIP).

12. Elements of the plan Three Key Outcomes
Avoiding inappropriate hospital admission.
Treating patients with the best care, in the best place, in the fastest time.
Discharge patients as soon as possible, improving patient flow.

13. Elements of the plan Seven Key Actions
Seven Day Health and Care services, physical and mental health services, including diagnostics.
Timely and efficient Admission Prevention Services.
Improved access to Urgent Care services with referrals for assessment and not admission.
Best practice urgent care and patient flow within Acute services.
Facilitating effective discharge (including PFC, Pathways 1, 2, 3 and DTOC reduction plan).
Ensure Mental Health support is consistent with national standards.
Winter Resilience Planning.

14. Elements of the plan Executive leads for each element of the plan.
Measurable KPIs throughout the plan.
Delivery plans monitored monthly, through Best Practice Urgent Care Committee.
Monthly SRG summary report on key outcomes and actions.
PMO being implemented to support process.
10 key actions for focus from within plan being agreed to see early improvements.

15. Challenging outcomes set by SRG
EAS 95% 4 hour target by end of June.
DTOC(delayed transfers of care) reduced to 50 by end of May:
Correct reporting of DTOC figures
Weekly monitoring board
Weekly case management process for complex patients
Escalation to senior leads for “executive action”