Gloucestershire Escalation Framework

2015/16

Maria Metherall: Senior Commissioning Manager

Urgent Care.

Presentation to the Health Overview and Scrutiny

Committee 12th January 2016

Content

• Escalation measures

• Escalation process

• Escalation level reporting

• Escalation actions

• Next steps

Escalation measures • Measures agreed for all major providers

• Measures relevant to parts of the system e.g.

Miscellaneous

Pre Hospital

In Hospital

Post Hospital

• Measures reflect both capacity and demand

• Weighted according to impact

• Use Public Health and Met Office information to inform

system preparation and response

Whole system escalation process

Step One

Miscellaneous measures Gloucestershire System Escalation Plan

Measures and monitoring

Miscellaneous

Number Type Lead KPI Green Amber Red Black Weighting

1 N/A CCGAre there adverse weather conditions or unforeseen circumstances that

are likely to affect services?0 -None

1 - Yes, with

limited

impact

anticipated

2 - Yes, with

moderate

impact

anticipated

3 - Yes, with

significant

impact

anticipated

5

2 GCS Are there staffing concerns within critical areas? 5

3 GHT Are there staffing concerns within critical areas? 5

4 SWAST Are there staffing concerns within critical areas? 5

5 IDT Are there staffing concerns within critical areas? 5

6 2G Are there staffing concerns within critical areas? 5

7 OOH Are there staffing concerns within critical areas? 5

8 111 Are there staffing concerns within critical areas? 5

100%

Threshold

Capacity1 - Yes, but

isolated

2 - Yes, but

increased

spread

across

system

3 - Yes,

entire

system

affected

0 -None

Pre hospital measures Pre-Hospital

Number Type Lead/Service KPI Green Amber Red Black Weighting

1 GCS SPCA - call volume per hour week (at the point of entry): weekday 8-9 10-12 13-14 >=15 4

2 GCS SPCA - call volume per hour week (at the point of entry): weekend 3-4 5 6 >=7 4

3 GCS Rapid Response - RAG rating (Referral rate in and numbers in service) 1 2 3 4 3

4 GCS MIIU - Patients waiting in departments at time of report: weekday <=16 17-23 24-30 >=31 1

5 GCS MIIU - Patients waiting in departments at time of report: weekend <=13 14-24 25-31 >=32 1

6 111 Abandonment rate as a % of calls <5% <8% <10% <15% 4

7 OOH Average waiting time for call back (weekend measure) <=20 mins <=60 mins 60-180 mins 180 mins plus 4

8 Primary Care Declared level of pressure

0 - No

pressure

1 - 2

localities

under

pressure

2 - 6

localities

under

pressure

3 - All

localities

under

pressure

5

9 SWAST 999 REAP level declaration 1-2 3 4-5 6 5

10 SWAST 999 Red Call Performance Percentage >76% 76->75% 75->60% <60% 4

11 SWAST 999 Green Call Performance Percentage >92% 92->90% 90->80% <80% 4

12 SWAST 999 Resource status below core output <5% 5-<10% 10-<20% >20% 5

13 SWAST 999 % calls above predicted demand<4% 4-<6% 6-<10% >10% 5

14 GCS SPCA - Abandoned call rate <5% 5-<8% 8-<12% >12% 4

15 GCS MIIU - % of patients seen within 4 hours 100% 98% 85% 75% 2

100%

Threshold

Demand

Capacity

In hospital measures In-Hospital

Number Type Lead/Service KPI Green Amber Red Black Weighting

1 GHT Number of patients waiting in department (GRH) 0-29 30-34 35-50 >50 5

2 GHT Number of patients waiting in department (CGH) 0-15 16-20 21-33 >33 5

3 GHT Longest wait to be seen (GRH) 15min 16-30min 30-60min >1hr 4

4 GHT Longest wait to be seen (CGH) 10min 11-25min 26-50min >50min 4

5 GHT Number of spaces in majors - including corridor beds (GRH) >1 1 0 -1 5

6 GHT Number of patients admitted (at time of entry since midnight) (GRH) up to 6 6-8 9-12 >12 4

7 GHT Number of patients admitted (at time of entry since midnight) (CGH) up to 3 3-5 5-8 >8 4

8 GHT Number of patients waiting over 4 hours in department (GRH) <2 <6 6-8 >8 5

9 GHT Occupancy across bed stock as a % (GRH) 85% 86-88% 89-92% >92% 5

10 GHT Total number of beds available at time of report (GRH) >10 6-10 0-5 <0 5

11 GHT Occupancy across bed stock as a % (CGH) 85% 86-88% 89-92% >92% 5

12 GHT Total number of beds available at time of report (CGH) >8 4-8 0-3 <0 5

13 GCS Total number of Community Hospital beds available >=10 6-10 0-5 <=0 3

14 GCS Total number of Reablement beds available >=8 4-8 0-3 <=0 2

15 GCS Beds closed due to Infection Control0

1 ward /

area

2-3 wards /

areas

>4 wards /

areas3

16 GCS Community Hospitals - Number of unfilled shifts (agency & bank) 1 2 3 4 3

17 SWAST 999 Handover delays since midnight (GRH) <1 1 - <2 2 - <3 >3 3

18 SWAST 999 Handover delays since midnight (CGH) <1 1 - <2 2 - <3 >3 3

19 2G Staffing within Mental Health Liaison Team. 80% 60% 50% 50% plus 2

20 2G Staffing within Crisis Team 80% 65% 50% 50% plus 2

100%

Capacity

Demand

Threshold

Post hospital measures

Post-HospitalNumber Type Lead/Service KPI Green Amber Red Black Weighting

1 GHT / GCS IDT - Number of patients in social work assessment <8 8-12 >=12 12 plus 4

2 GHT / GCS IDT - Number of patients on Medically Stable List waiting 1 days <12 13-17 >=18 18 plus 4

3 GHT / GCS IDT - Number of patients on Medically Stable List waiting 6-9 days <10 11 >=12 12 plus 4

4 GHT / GCS IDT - Number of patients on Medically Stable List waiting Total <40 40-45 45-50 50 plus 4

5 GHT / GCS IDT - Patients waiting for home based reablement <3 4 >=5 5 plus 4

6 GHT / GCS IDT - Number of patients awaiting Reablement bed <3 4 >=5 5 plus 4

7 GHT / GCS IDT - Number of patients waiting for Community hospital bed <6 7 >=8 8 plus 4

8 GCS SPCA - Number of patients on SPCA working list at time of report <15 15-20 21-30 >30 3

9 GCS SPCA - Number of patients on SPCA pending list <=10 11 12-14 >=15 3

10 GCS Number of community hospital beds available 12 plus 6-11 5-1 0 3

11 Arriva Patients booked on day waiting more than four hours for discharge 0 1-4 5-8 >8 3

100%

Capacity

Demand

Threshold

Escalation level report

Escalation level report

Step 2

Extract from escalation action cards

Number Organisation Action

1 2G

MHLT to ensure all referrals are verbally responded to within 2 hour target and subsequent

response is in keeping with level of risk identified using risk matrix

2 GHT

Chiefs of service contacted to contact all speciality Directors to do walk around of their areas

to increase discharges

3 GHT Activate redeployment plan and allocate staff to areas of greatest pressure

4 GHT Instigate RATing in ED and ACUs

5 GHT

All Matrons to attend their key areas of responsibility to ensure all escalation actions are

underway

6 GHT Senior ED Manager/Clinician to attend ED and ensure consistent and effective coordination

7 GHT

Acute physicians mobilised to review and discharge from ED and prioritise patients for

transfer to ACUs

8 SWAST 999 Undertake actions in accordance with agreed REAP level

9 2G Regardless of level of risk and within resource available will prioritise ED referrals

10 2G

MHLT manager to reallocate resources (staffing) from Community Hospital Liaison Service to

prioritise and assist with ED referrals

11 GCS Instigate temporary service closure plan

12 GCS

Instigate whole system redeployment plan in order to respond to capacity and demand

constraint

13 GCS SPCA to action no OOC repatriations and no direct admissions unless agreed by lead

14 GHT Ensure all support services (radiology etc.) continue working until activity completed

15 GHT Cancel elective activity to facilitate increasing discharges and creation of bed capacity

16 GHT All senior managers: GM and above to cancel meetings to drive operational recovery

17 GHT

Reduce clinics by 1 hour to enable medical specialities with bed shortfalls to do extra ward

rounds

18 GHT Full capacity protocol to be implemented

19 SWAST 999 Undertake actions in accordance with agreed REAP level

In-Hospital

Next Steps

• Review as part of whole system winter

review workshop

• Using data to forecast and support

proactive planning

• Primary Care

• Extended intelligence e.g. pharmacies

• Completion compliance