emergency dept what should we aspire to deliver!? · 2017-10-26 · emergency care system...
TRANSCRIPT
Getting the best ‘value for money’ from your
Emergency Dept – What should we aspire to deliver!?
Dr Taj Hassan
Twitter : @RCEMpresident
OBJECTIVES
Where we are?
Where we need to be?
How to get there ?
Elephants in the room!
Demand Complexity Staffing …. Money! Shared values
Collaboration Culture System leadership
Emergency care system performance
May 2017 Priorities for the next government
X X Understanding what it means to work in an ED with <80%
System performance
97.70% 97.00%
94.70% 94.80% 95.60% 95.90%
94.50% 93.70%
94.90% 95.40%
93.50%
91.10%
93.40% 94.40%
93.50% 92.70% 92.60% 92.50%
88.90%
87.50%
91.10% 91.40%
87.40%
81.80%
85.40% 85.90%
81.90% 81.40%
75%
80%
85%
90%
95%
100%
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
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2010-11- - -2011-12- - -2012-13- - -2013-14- - -2014-15- - -2015-16- - -2016-17- -
Type 1 Attendances, Admissions and Four Hour Standard Quarterly Performance 2010 - 11 to 2016-17
Type 1 Departments - Major A&E Emergency Admissions via Type 1 A&E
Percentage in 4 hours or less (type 1)
STAFFING A paradigm change in EM
ED Staffing levels Senior Decision makers (SDMs) in ED – what do
they do? • Command & Control
• Team Leader Resus Room
• Senior sign off /supervise juniors
• RAT function
• CDU/ Ambulatory care
• ‘Queue bust’ ( balancing risk)
FY1/2
SAS
EM CT1-3
Phy Associates
Adv Care Practitioners
Clin Devpm Fellows MTI
CESR
ST4-6
Consultant EM with“depth & breadth”
delivery models of 1-4 Cons on shift - depending upon
demand
EM workforce planning
ENPs
ATTRACT RECRUIT RETAIN
GP CT1-3s
Senior Decision Maker Junior Clinical Workforce
Specialty Doctor
MTC or equivalent
Mid sized system
Small / Remote & Rural
Sustainable & tailored workforce planning for ED
Understanding the terminology
Career burnout
Compassion fatigue
Wellbeing
Resilience
Sustainability & satisfaction in workplace
• RCEM strategy
• DH / NHSI / NHSE
• BMA
• HEE
Systems • Front end design
• Virtual & physical co-location
• Resourced ‘streaming’
• Optimal gatekeeping with AEC & CDUs
Complex & confusing nomenclature / signage for patients!
System Quality Indicators Redirection, Hubs & Co-location, wider system resilience
Tailored cost effective solutions Eg primary care streaming for 10-15% of patients at ED
6. System resilience
• Supporting funding for wider system ( social care) – Kings Fund data on GDP
• More acute care bed base ( OECD on beds)
• Strategy for elderly & frail
• Will address exit block & crowding
Making STPs work!!!
• Focus on quality care for patients • Involve the clinical experts • Get economists in to help • Supporting networked solutions • Remote & Rural strategy
• LEARN THE LESSONS OF HISTORY!!!
Elephants in the room!
Shared values
Collaboration
Culture
System leadership
Influencing politicians & policy makers!
Building bridges & alliances
• Social care funding • Acute care beds • Staffing – short term • & MEDIUM TERM SOLUTIONS :
RCEMVision2020
System leadership
“ Management is about
coping with complexity.
Leadership is about coping
with change….”
John Kotter
Valuing training
The future ( present!)
Artificial Intelligence & decision support IT & Big data Education and training using AR / VR tech
Getting the best ‘value for money’ from your
Emergency Dept – What should we aspire to deliver!?