ED Performance

Des FitzGeraldConsultant in Emergency Medicine, UHW

Clinical Lead for UnScheduled Care

ED Performance

In God we trustAll others bring data

UnScheduled Care

ED/AMU

Psych

OPD

Day Wards

Day Cases

Paeds/Mat

ingress process egress

Egress

Process

Ingress

CAPACITY• Flow• Discharges

DEMAND• Attendances• Admissions

Patient Experience Time P E T

INMO Trolley Count

DEMAND

CAPACITY

ED Crowding

DATA acquisition iPMSGet our house in order• ED processes / streaming /

admission avoidance

AMU / AMAU Co-horting on wardsWard based “firms” vs teams

Patient Flow Coordinator Visual Hospital Delayed DischargesSharing good news /

achievements

DATA acquisition iPMS

Get our house in order• ED processes /

streaming / admission avoidance

Data Acquisition

Unrecognised sources

Unaware of numbers

Incorrectly named

Incorrectly counted

The unpredicted predictables

iPMS

New IT system UHW

November 2013

Teething Problems

Lack of clinician buy-in

Poor compliance

Excellent opportunity to instil data and performance focus

Get our house in order

• Admitted patients are not “ours”• We have no control over them

• Emergency Medicine patients are our patients• Therefore do the best for OUR patients

25% of ED attendances are admitted.

Get our house in order

• Admitted patients are not “ours”• We have no control over them

• Emergency Medicine patients are our patients• Therefore do the best for OUR patients

75% OF ATTENDANCES ARE DISCHARGED!!

6hr YTD 9hr YTD ADMITTTED 6hr PET 9hr PET

DISCHARGED 6hr PET 9hr PET

A 59% 74% 50.4% 73.9% 65.7% 81.0%

B 72% 87% 70.1% 81.6% 68.6% 87.1%

C 62% 77% - - - -

D 76% 86% 62.9% 72.5% 71.6% 79.9%

UHW 79% 87% 44.3% 57.4% 88.9% 95.6%National Rank (UHW)

#3 #7 #1 #4

PET 2013

PET 2014

How others see you…

Why the deterioration in Performance in Nov & Dec?

Aug-14 Sep-14 Oct-14 Nov-14 Dec-1450.0%55.0%60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

80.42% 81.44% 81.55%79.10% 78.42%

% of pt with a Total ED Time < 6 hours (Target :95%)

Aug-14 Sep-14 Oct-14 Nov-14 Dec-140.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

9.44% 10.45% 11.28% 12.72%14.42%

% of pt with a Total ED Time >9 hours (Target :0)

Aug-14 Sep-14 Oct-14 Nov-14 Dec-140.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%4.5%5.0%

0.5%0.8%

1.2%

1.8%

3.7%

% of pt with a Total ED Time >24 hours

Aug-14 Sep-14 Oct-14 Nov-14 Dec-140

100

200

300

400

500

600

700

222280

397

493

648

average time 'lodged' in ED (mins) (i.e.awaiting bed allocation)

Nov Wk 1

Nov Wk 2

Nov Wk 3

Nov Wk4 Dec Wk1 Dec Wk 2.

Dec Wk 3.

Dec Wk 4.

Dec Wk 5.

Jan Wk 1.0

5

10

15

20

25

30

35

2022

29 29

24 23

26

2217

24

16 16

2119 19 19

24

25

17

22

Delayed dis-charges 2014Delayed dis-charges 2013

Delayed Discharge Counts Weekly snapshots: Nov & Dec 2013 and 2014

July-Dec 2013 July-Dec 201430

35

40

45

50

55

60

65

70

75

80

55.42

66.38

AvLOS for Med Pts discharged with LOS>30days

days

Stay Focussed!

UHW Highest performing ED in the country forNON-ADMITTED PATIENTS

Week 4 2015

94.9% for 6 hr97.5% for 9 hr

But not focussed on “targets”