wrightington, wigan and leigh nhs foundation trusts

Improving health outcomes across England by providing improvement and change expertise

Wrightington, Wigan and Leigh NHS Foundation Trusts


Dr Sanjay AryaMBBS (Hons), FRCP (London), FRCP (Glasgow) Consultant Interventional CardiologistDivisional Medical Director, Division of MedicineClinical Lead for Heart Failure, AQuA, North West

Delivering NHS Services, Seven Days a Week


‘‘Patients who are admitted to hospital believe that they are entering a place of safety, where they, their families and carers, have a right to believe that they will receive the best possible care’’.

‘‘Yet there is evidence to the contrary. Patients who are unwell, or become acutely unwell in hospital, may receive suboptimal care’’

Dr Mary Armitage, Guideline Development Group ChairAcutely ill patients in hospitalRoyal College of Physicians

Delivering NHS Services, Seven Days a Week


Patients and family expect that the NHS will provide safe and high quality service consistently seven days a week

There is a variation in care depending upon time of the day and the day of the week

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=qMKPl5H3OlCN8M&tbnid=-PYaydi3ouWZbM:&ved=0CAUQjRw&url=http://www.thejournal.ie/galway-university-hospital/news/&ei=LxJIUo_4FM6ZhQfl_YCIAg&psig=AFQjCNFzy8IRcbeHm-pEcyFZ_C5Ae-Xsnw&ust=1380541207679210

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Where there is a 7 day service, there is no observed difference in mortality rates in the week and at weekend(Bell M et all: The New England journal of Medicine 345:9) (Schmulewitz L et all: Clinical medicine Nov 2005)


Weekend mortality: Wigan 2001-11

2011 Fosters report: 5th from the bottom

474 excess deaths


HSMR: March 12 – Feb 14


Our Patients

Outcome of Real Time Patient Surveys conducted monthlyOutcome of Real Time Patient Surveys conducted monthly Apr-14 May-14

Have staff treating and examining you introduced themselves? 90.8% 98.5%

Did you find someone to talk to about your worries and fears? 83.2% 88.5%

Do you think the hospital staff did everything they could to help control your pain? 93.5% 93.9%

If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? 87.0% 91.6%

Have you been involved as much as you wanted to be in decisions about your care and treatment? 77.7% 85.5%

Have you been offered a choice of food during your stay? 96.2% 97.7%

Has there been healthy food on the hospital menu? 91.8% 92.4%

Have you been involved in decisions about your discharge from hospital? 57.1% 57.3%

Do you know which consultant is currently treating you? 72.8% 87.0%

Have you been given enough privacy when being examined, treated or discussing your care? 99.5% 98.5%

Have you always had access to a call bell when you needed it? 98.4% 93.9%

During your stay have you been treated with compassion by hospital staff 98.4% 98.5%

Have you been given the care you felt you required when you needed it most? 95.1% 98.5%

AVERAGE 87.8% 90.9%


The 10 Clinical Standards

Patient Experience

Time to first consultant

review

MDTReview

Shift Handovers

Transfer to community and Primary

and social care

MentalHealth

Quality Improvement Diagnostics

On-going review

Intervention/Key services


Addressing delivery of the national clinical standards for 7 day services

‘A&E Clinical Quality Indicators’

Mr Ayaz AbbasiMBBS , FRCS, FCPS, FCEM, PGC

Consultant, Emergency Medicine

Clinical Director, Emergency MedicineWrightington, Wigan & Leigh NHS Foundation Trust


Weekends


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Monday to Friday


A&E Clinical indicators

• 1 Ambulatory emergency care• 2 Unplanned re-attendance rate • 3 Total time in the A&E department • 4 Left without being seen (LWBS) rate • 5 Service experience • 6 Time to initial assessment • 7 Time to treatment • 8 Consultant sign-off


Unplanned Re-Attendance Rate

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14

Ra

te

% UNPLANNED REATTENDANCE TARGET

Unplanned Re-Attendance Rate


Left Without Being Seen Rate

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14

Ra

te

% DID NOT WAIT TARGET

Left without being seen


Total time in EDSite performance against national benchmarks and performance

00:00

01:00

02:00

03:00

04:00

05:00

06:00

May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14

Tim

e (

hh

:mm

)

Threshold Non Admitted 95th


A&E 4 Hours

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

CentralManchester

Stockport SouthManchester

Pennine Tameside Wigan Salford Bolton

Greater Manchester A&E Performance by Acute Trust1st April 2013 to 31st March 2014

Trust Stretch Threshold Monitor Threshold National Mean

Please note activity for Central Manchester is Level 1 activity only.


Time to TreatmentSite performance against national benchmarks and performance

00:00

00:15

00:30

00:45

01:00

01:15

01:30


Tim

e (

hh

:mm

)

Target Median


Initial AssessmentSite performance against national benchmarks and performance

00:00

00:05

00:10

00:15

00:20

00:25

00:30


Tim

e (

hh

:mm

)

Target 95th Percentile


Ambulatory CareProportion of Attendances who are Admitted

0%

10%

20%

30%

40%

50%

2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/15 Q1

Ra

te

% A&E Admissions with diag Cellulitis

% A&E Admissions with diag DVT


Consultant sign off

• Non traumatic chest pain in age seventeen and above.• Any re attendance within 72 hours with a similar condition.• Febrile child less then one year old.

All these conditions if discharged from ECC require consultant sign off.


NB/ August Audit:◦ Sign off done – 46%◦ Sign off not done – 54%

SIGN-OFFDONE SIGN-OFF NOT DONE

CHEST PAIN 45% (34/ 76)

55%(42/ 76)

CHILDREN <1YR WITH PYREXIA

9% (2/ 22)

91% (20/ 22)

REATTENDERS 36% (4/ 11)

64% (7/ 11)

OVERALL 37% (58/ 109)

63% (69/ 109)


Friends and Family Test

Accident & Emergency Friends & Family TestQuality Scores for the Greater Manchester Area

Trust Jan Feb Mar April May

Wrightington, Wigan & Leigh NHS FT 69 75 70 66 63

Central Manchester University NHS FT 62 50 64 61 60

Bolton NHS FT 59 49 44 47 56

University South Manchester NHS FFT 55 54 47 53 58

Salford Royal NHS FT 56 58 56 58 59

Pennine Acute Hospital NHS Trust (Oldham Hospitals) 48 42 41 45 51

Stockport NHS FT 45 42 42 46 41

Tameside Hospital NHS FT 27 15 11 21 38


Thank you


The whole health community needs to address the problem of increased mortality over the weekend

•Engaged clinicians (medical,nursing,physio,OT) and managers•Developed leadership: Divisional Director & 4 Clinical Directors•Involved everyone: Martin Farrier’s weekly mortality data:

There should be a 7 day access to all aspects of care: medical, nursing, diagnostics, GPs, Social services, Palliative care

• COE Consultants in the community – supporting GPs• Engaged Nursing / Care homes – advanced care planning• Improved end-of-life care for terminally ill patients – rapid discharge

Is there a solution? Wigan experience

Why are there more deaths? ‘Weekend Effect’


Increased Consultant presence: Cost effective / Reduces mortality

• Recruited more A&E and MAU consultants• Increased presence of Consultants on A&E, MAU and Medical wards on weekends and bank holidays • 7 day 12 hour consultant delivered/presence service



Right patient Right ward, beyond the first 24 hours of admission

•Specialists felt engaged, valued & comfortable in managing patients•Increased daily senior review on medical wards•Improved patient pathway / journey / care bundles


Support services will also need to adopt 7 day working practice ifthe full benefits of 7 day Consultant service are to be realised

•Increased presence of Physio, OT and Social services over weekends and bank holidays

•Increased availability of diagnostics over weekends and bank holidays




Addressing delivery of the national clinical standards for 7 day services

Two questions to address –

1) What are the key challenges around the clinical standards?

2) What suggestions do you have on how those challenges can be overcome?

Please use post-it notes to capture your thoughts on key challenges in your locality, you may add your contact details if you would like to discuss this further with us at a later date


Refreshments

wrightington, wigan and leigh nhs foundation trusts

Documents

week patients

total time

hours time

clinical medicine

mortality rates

national clinical standards

emergency medicinewrightington

reviewinterventionkey