1. UNDERSTANDING ED ATTENDANCES IN LANARKSHIRE
Dr Veronica Devlin
Lean Leader NHS Lanarkshire
Prof Graham Watt
Department of General Practice
Glasgow University

3. population 556,000
3 ED’s
194,000 new attendances in2008/09
10% of ED attendances are GP referrals
Population over 65 close to Scottish average

4. Bed complement
•Monklands Hospital -478 inpatient beds
•Hairmyres Hospital-353 inpatient beds
•Wishaw Hospital -633 inpatient beds

5. A Day in the Life of Monklands

6. CONTEXT Mostly urban Set in centre of Airdrie High deprivation
High number of single handed GP’s
Average 66,500 new attendances per year

7. Methodology ED records pulled for 24 hours – Tuesday
Examined by EA Programme Manager and LTC manager or Charge Nurse from ED
Categorised into broad groupings

8. Attendance Profile 165 new attendances Admissions 12 surgical
2 diverted from Wishaw
5 ortho including 2#NOF
33 medical
1 psychiatry
1 ITU
1 Unknown disposition

9. Medical 1 rash 1 palliative care 1 collapse 1 haematemesis 1 headache
9 chest pain
8 chest infection or SOB
2 alcohol intoxication
1 accidental o/d
1 respiratory failure
1 intentional o/d
1 seizure
1 alcohol withdrawal
1 asthma
1 rash
1 palliative care
1 collapse
1 haematemesis
1 headache
1 pneumonia
1 off legs
1 respiratory failure
1 unclear!

10. “Primary Care” Appropriate
3 referred by NHS 24
1 by police
1 by GP receptionist- 4/12 old foot inj
1 by GP - reflux
1 by ED for detox team
4 dialled 999
10 children, 5 of those in working hours

11. Long Term Conditions 9 with at least 1 LTC
2 known to be on SPARRA register
1 with leg pain self referred, 999, known OA 10.00, discharged
4 admitted with exac COPD
1 admitted with accidental OD
1 incidental head injury
1 ? CVA in patient with COPD and IHD
1 with known IHD admitted with chest pain

12. Alcohol and Drugs
18 presentations where alcohol was involved – >10% of presentations
6 presentations where drug use mentioned
1 heroin o/d signed IRD

13. Nursing Home 23 nursing homes in catchment
Average 2 admissions from NH per day
1 documented care home admission

14. GP OOH 10 patients diverted to GP OOH at triage
2 were 999 self referrals
1 abdo pain
1 chest pain
2 earaches
1 sick baby
2x20 year olds short of breath
2 back pains
1 unwell 43 year old

15. GP APPROPRIATE TIME OF ARRIVAL

16. Also of note… 1 cardiac arrest who died 1 multiple trauma who breached
1 standby for respiratory failure who was admitted
18 alcohol related attendances
5 drug related attendances

17. Prospective Audit of “Elsewhere appropriate attendances”at the ED
Prospective clinician collected subjective data for month of June
Acute injuries excluded – musculoskeletal pain non-trauma included
Hairmyres useable audit forms
Monklands 90
Wishaw

18. Condition
Age and gender distribution
Time of registration
Referral Source
Symptom Duration
Outcome

19. Monklands by Condition n=90

20. Monklands Gender Split

21. Monklands Age Spread

22. Monklands Attendance Spread

23. Monklands Referral Source

24. Monklands Duration of Symptoms

25. Monklands Outcome

26. NHS Lanarkshire overview

27. One of the highest 999 ambulance call to ED attendance conversion rates in Scotland
82% versus 72%

28. DNW’S every month

29. There is a 3 fold variance in GP practice A&E emergency referral rates - from the highest to lowest referring practices - this is consistent over the last 4 years

30. mean rates per 1,000 population - growing as follows
Rates have been growing year on year over the last 4 years
mean rates per 1,000 population - growing as follows
264 to 279 to 292 and to 302 in 2008/09
+6%, +5% and +3% respectively in each year

31. Standardised emergency admission rates
NHSL is consistently higher than the Scottish average over the last 6 years - although the gap is narrowing in recent years

32. There is a 200% variance in GP practice emergency admission rates - from the highest to lowest referring practices in 2007/08

33. There is a 100% variance in GP practice OOH contact (call) rates - from the highest to lowest referring practices in 2007/08

34. Emergency admissions in context - they account for 75% of all acute admissions and 83% of all acute bed days.
65% of all direct emergency GP referrals to the A&E Department are admitted (49% medical and 16% surgical)

35. Demand has increased by 9% or circa 16,000 new attendances over the last 3 years.

37. 98 GP Practices
Cover paper for each Practice
Information Pack 1 - A&E attendances
Information Pack 2 - Emergency admissions

43. GP Information Pack 1 - A&E Presentations
GP Practice profile 1 - demography & deprivation
GP Practice profile 2 - Age & deprivation
GP Practice - QOF prevalence benchmarking
GP Practice benchmarking
GP Practice ranking
GP Practice referral source & flow group
Charts comparing trends over time

44. GP Information Pack 1 - Emergency Admissions
6 year trends - “Navigator” generated
Admission numbers and rates
Bed day numbers & rates
Elective shown for completeness
CHI population change
Each GP Practice benchmarked against:
NHS Lanarkshire
NHS Scotland
North CHP
South CHP