1. PATIENT ARRIVES AT EMERGENCY DEPARTMENT TRIAGE NURSE EMERGENCY DEPT 2 ND NURSE REVIEW EMERGENCY DEPT MDT MEETING AYRSHIRE CENTRAL BIGGART HOSPITAL COMMUNITY HOSPITAL STEP DOWN BEDHOME CDU 2 BEDS 24 HRS 72 HR ASSESSMENT BED 5D/5E WARD 3EHOME IN PATIENT BED FRAIL ELDERLY PATHWAY PATIENT IDENTIFIED AND LISTED AS POTENTIAL FOR PILOT BY ADMIN STAFF FRAILTY INDEX SCORE CALCULATED FRAIL ELDERLY PILOT TEAM REVIEW HELD IN REAL TIME IN THE E.D. AS AND WHEN REQUIRED

4. TEAM IN ACTION

6. TEAM STILL IN ACTION

7. Monday 13 th May 2013 Feel a bit apprehensive In general, worked relatively well on first day Excited about the possibilities that this offers Positive experience, good that it was a bit quieter today to get to grips with process Cap of 8 removed Med rec timing crucial Red dot process Getting to grips with ED processes Needs co- ordination Pleased that we all got through it Over 65 : 22 (5 for pathway.) 3 to CDU (would have gone to 3E) 2 home Total admissions avoided: 3 2 empty beds at 5pm 9am4pm

8. Tuesday 14 th May Good examples of making a difference Much more natural slotting in of MDT today Admin co- ordination made a huge impact Can’t underestimate the impact of having Dr Wallace in ED GP joining team Sleepless night Keeping track on patients Impressed with the progression Huge difference made Empty beds in 3E – that never happens! Staff excited after yesterday Amazing! Revolutionised the service! Over 65: 29 (16 for pathway.) 12 home(2 NH). 2 to 72 hr beds. 1 to 5D. 1 to 3E. Total admissions avoided: 9 8 empty beds at 5pm 9am4pm

9. Friday 17 th May 2013 It’s Friday! A quick chat with ED staff this morning to clarify processes Having MDT meetings on the floor rather than coming up. Saving time Not the same amount of stress in the wards Huge impact on 3E having empty beds Not so many people sent to 3E – most going straight to ward Pts seem to have been safely discharged in a shorter period of time Some minor adjustments Early contact with families, invaluable 9am4pm 10 empty beds in 3E

10. OUTCOMES

11. ‘AVOIDED’ ADMISSIONS

12. ED JOURNEY TIMES IN CONTROL GROUP

13. ED JOURNEY TIMES DURING PILOT WEEK

14. ED JOURNEY TIMES OF UNDER 65’S CONTROL GROUP

15. ED JOURNEY TIMES FOR <65’S IN PILOT WEEK

16. TIME TO COMMENCE GCA