Acute Service Management

Liz MooreDirector of Acute Services

NHS Ayrshire & Arran

Background

• Decide to Admit – 2009 • Constrained Facilities – assess/admit through Emergency

Departments

• Business Cases – Building for Better Care – 2009/10

• Emergency Care Quality Improvement Programme – 2011

New DevelopmentsBusiness Case – 2012 / 2013

University Hospital AyrEmergency Department

Construction commences – September 2014Construction Complete – December 2015

Combined Assessment Unit

Construction commences – December 2015Construction Complete – March 2017

• 29 En-suite Rooms• Assessment Bays• Ambulatory Areas

University Hospital CrosshouseCombined Assessment Unit

Construction commences – October 2014Construction Complete – March 2016

• 35 En-suite Rooms• Assessment Bays• Ambulatory Areas

Management StructureDirectors

Unscheduled Care / Planned Care / Care of the Elderly Community Services

Managers

Speciality specific across sites

2 Acute Hospitals·

Ayr – 350 Beds· Crosshouse – 650 Beds

Community Hospitals·

Ayrshire Central Hospital· East

Ayrshire Community Hospital·

Kirklandside Hospital·

Girvan Community Hospital · Arran War Memorial Hospital· Lady Margaret Millport

Management Structure

• Acute Services Director – University Hospital AyrUniversity Hospital Crosshouse

• Health & Social Care Partnership developments

• Restructured – Hospital Specific Management (Ayr/Crosshouse)

• Emergency Care Quality Improvement Programme/LUCAP

Whiteboards

Continuous Assessment

Community Wards

GP AA’s

CDUs

ACPs

Frail Elderly Pathway

Site Management

Hospital Huddles

Weekend Discharge

Morning Discharge

Safer Patient Developments

• New structure – Safety Focus/Hospital Team Focus

• Get to really know site/people. Help change happen

• Service issues every day / weekend / overnight

• Job Roles – 7 day working

• Assistant Director of Acute Services for each site

• Hospital Huddle – January 2014

• Thanks to Lynn – Edinburgh Royal Infirmary

• 30+ staff attended walk/talk through

• Associate Medical Director and SPSP Fellow

• Set Date – Hospital Huddles/7 day working – June 2014

Safer Patient Developments

Launched TogetherHuddle / 7 Day Working

• Huddle Chaired by Assistant Directors

• 8am on both sites: 30 – 50 staff attend

• Safety: Scripts – Focused informationSafety Issues/Patient FlowAnticipate activity of day/respond

• Visible Commitment of Team/Managers/Collective Responsibility for hospital

• University Hospital Ayr – 12 Staff: – Assistant Directors– GMs– AGMs– CNMs

• University Hospital Crosshouse – 16 Staff: – Assistant Director– GMs– AGMs– CNMs

• Weekday shift 12noon – 8pm: Overnight on-call

• Weekend shifts (same manager): Friday 12noon – 8pm Saturday 8am – 4pm

Sunday 8am – 4pm Remainder of weekend -On-call

Extended Days/7 Day Working

Feedback StructuresWhat do our Managers say?

7 Day Working• Hard to do jobs

when no others working weekends

• Emails pouring in over weekdays when on days off

Weekend SupportLess calls late at night/weekends

Huddles Brilliant!

• Hospital has become closer/more sharing of everything!

• Hard to imagine not having them

• Taken Team work to next level

Gained insight into pressures

across whole system

Visible Proactive

Leadership

Immediate practical support valued

Less weekday meeting time

Manager presence valued by

staff

Performance visibly improved

Outcomes

• Rapid response to adverse events/support staff

• Reduction in Out of Hours activity which should have been completed in-hours/tea time patient flow blocks

• Improves patient flow and performance against 4 hour standard

• Enhanced multi-disciplinary working

• Morning discharge?

• Weekend discharge?

NHS Ayrshire & Arran A&E 4 hour performance

January 2013 to August 2014

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

75%

80%

85%

90%

95%

100%

NHS A&A 95%

UH Crosshouse and UH Ayr A&E 4 hour performance

January 2013 to August 2014

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

75%

80%

85%

90%

95%

100%

UH Ayr UH Crosshouse 95%

Question

How do we really deliver patient discharge before 12noon?