Edge Talks November 2016: Fixing Patient Flow
Post on 21-Jan-2017
Fixing flowSasha KarakusevicFriday 4th November 2016 at 9.30am BST
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The Team TodayTwitter and Chat Room MonitorDom Cushnan@DomCushnan
Session ChairJanet Wildman@Jwildman1
Sasha Karakusevic @karas01
Todays discussionKey points from my recent Nuffield Trust reportDecision making in complex environmentsWhat to do when the data doesnt fit
Are you stuck?Wasjig Cone-gestion
How different are the achievers?
Stand back to see the big picture
Flow depends onLinking:Defined populationAppropriate capacityAn efficient process
Source: Sara Adi Kreindler BMJ Qual Saf 2016 doi:10.1136/bmjqs-2016-005438
Mind the gap
Demand and capacity arent matched
Which line would you like to change?Which line can you change?
Leading to congestion
Fixing flowMeasure and manageTransformAvoid
Midnight is not a good time to measure operational demand in the modern hospital
Peak occupancy and peak flow
Peak occupancy occurs in the morning but peak flow occurs between 2 and 7 pm
Can your systems keep up? Where are the constraints?
Queues build up rapidly if supply and demand are not matched
Almost 2 hours waiting time is added to arrivals in the early evening
Does your bed change team look like this?
SolutionsStart with what you have got
Actively involve support services
Is your control and command centre set up for the volume of activity?
Move to real time data
58% of patients are treated through 10% of the used spaceThis group has grown by 17% over the 6 years to 2014/15
How easy is it to reverse the changes that got us here?European Working Time DirectiveDay surgeryAdmission on the day of surgery12 hour shiftsChanges in general practiceProtected meal timesPressure on medicine (especially)Changes in social care
Re-thinking long stay
More patients appear to leave hospital to residential and nursing care.
Decision making in a complex environment
Listen very carefully to storiesPut the elements togetherAdopt a structured and non-hierarchical approach
When the data doesnt fitCheck the data and the reliability of the existing system (Head)Use your intuition (Gut)Listen carefully to what people are sayingRemember your values (Heart)
Unless there is an error in the data it is likely there is a change in the environment that will need new thinking and new approaches to resolve
In conclusionThe environment is changing rapidly with an increasingly large elderly and complex populationResources are not available to tackle this new demand on a business as usual basisThere are opportunities to manage flow better and redesign systems to expand care out of hospital
Time to remove the blockages
Next EdgeTalk SessionEmpowering people to be heard and helping leaders to listenCreating the #AHPsMandate
Dr Joanne Fillinghamm
Dr Peter Thomond