23 rd September 2009 NHS Ayrshire & Arran The Key Points from: - PowerPoint PPT Presentation

HEAT Targets: Network Event 23 rd September 2009 NHS Ayrshire & Arran The Key Points from: The Early Analysis of Patients Presenting at A&E Bryan Samuel: Senior Information Analyst (A&E) 23/09/2009 B Samuel 2009

The HEAT Target T10 The HEAT Target T10 • Deliver local Improvement Trajectories Deliver – A reduction in unplanned presentations at A&E – Metric: Average attendance/100,000 population – Target: Q4 2010/11 to be below Q4 2007/08 Sustain • Sustain the maximum 4hr A&E treatment limit – From registration to discharge/admission/transfer Current Focus of Analysis • Improve whole systems winter planning • Improve access to emergency care 23/09/2009 B Samuel 2009

A& E Data Requirements A& E Data Requirements • 4 hour A&E Treatment Limit – Provide data for weekly performance reviews • Parameters of Interest: A&E Demand Profiles, Time- to-Triage, Time-to-First-Consult & Total-Patient-Wait – This is relatively straight forward! • Reducing Unplanned A&E Attendance – Need to identify and redirect suitable patients to more appropriate non-A&E treatment paths – This is more of a challenge! 23/09/2009 B Samuel 2009

B Samuel 2009 Daily A& E Performance Data Daily A& E Performance Data 23/09/2009

Reducing Unplanned A& E Reducing Unplanned A& E Attendance Attendance 1. We need to understand our baseline position How are the profiles of A&E patients changing? – – Can patients be grouped into logical categories? – How many patient groups are appropriate for A&E? 2. Why are inappropriate patients attending A&E? – Are there more suitable treatment pathways available? – If not, can we use our resources to put them in place? Once alternatives are available, how can we change – patient behaviour? This is where we are currently! There are plans to collect more of this information 23/09/2009 B Samuel 2009

The Focus of Our Analysis The Focus of Our Analysis (so far...) (so far...) • March 2009 – A&E Attendance by Triage Category: • Patient Disposition, Referral Method, Age Profile, Postcode Area & Distance to A&E • May 2009 – A&E Attendance by Gender: • Age Profiles & Referral Method – A&E Attendance by the 17-35 Age Group: • Referral Method by Gender & Disposition by Gender • August 2009 – A&E Attendance age & gender profiles from 1999-2008: • A look at demographic trends over this timescale 23/09/2009 B Samuel 2009

EADT Information Network 6 th March 2009 NHS Ayrshire & Arran Crosshouse Hospital A&E Attendance Review Stewart Cardwell Service Improvement Lead - Patient Access 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance by Triage C ategory 1st Nov 2007 - 31st Oct 2008 R ed Blue Orange 335, 1% 1078, 2% 5673, 9% G reen 31353, 48% Yellow 25560, 40% Red: Immediate Resuscitation (1) Green: Standard (4) Orange: Very Urgent (2) Blue: Non-urgent (5) Yellow: Urgent (3) 23/09/2009 B Samuel 2009

Blue/Green Patients! Blue/Green Patients! • By definition these are: – non-urgent and standard patients • They make up 50% of A&E Attendees • The best chance of identifying some patients suitable for non-A&E routes? • At least they deserve a closer look! 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance (% of Total) by Triage C ategory (Triage = Blue/G reen) 1st Nov 2007 - 31st Oct 2008 23.7% Almost a quarter of all patients are B/G & 25.0% are discharged from A&E with no review 20.0% Attendances 15.0% Over 1% of all A&E patients are B/G & 9.1% leave before being assessed 10.0% 6.4% 4.5% 3.8% 5.0% 1.3% 1.0% 0.4% 0.3% 0.1% 0.0% 0.0% 0.0% 0.0% S t r P P y P i c e C e w m l A O O t G t a s i h i n O P n n e t n d t e i E i O D s r i o A o p o l v C m e a t A s e t p t s o a s R e E r d e s H o M e g & r e R o f t a r A e s a W r n R e s e d h A g o h e i c r p g t t s a O e a r r i h D r R a e o c t h f s e f i m c e i R D s B d i D A t f e L Disposition 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance (% Total) by R eferral - 'Discharge No R eview' 1st Nov 2007 - 31st Oct 2008 25.0% 20.0% Over 21% of all A&E patients refer themselves & are discharged with no review Attendances 15.0% 10.0% 5.0% 0.0% Health This Other S chool/C ol S ocial S elf NHS 24 999 G P Other ADOC P olice C are P rison Hospital Hospital lege S ervices P rovider 21.2% 1.0% 0.9% 0.9% 0.3% 0.3% 0.1% 0.1% 0.1% 0.0% 0.0% 0.0% 0.0% DNR R eferral S ource 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance by R eferral - 'Discharge No R eview' (incl LBA) 1st Nov 2007 - 31st Oct 2008 16000 14000 Left Before Assessment 12000 10000 Attendances 8000 Almost 25% of DNRers who arrive by 6000 ambulance leave before being assessed! 4000 2000 0 Health This Other S chool/C ol S ocial S elf NHS 24 999 G P Other ADOC P olice C are P rison Hospital Hospital lege S ervices P rovider 631 33 112 22 11 5 11 4 0 0 0 0 1 LBA 12967 619 468 531 199 180 77 64 35 26 9 6 5 DNR R eferral S ource 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance Age - 'Discharge No R eview' 1st Nov 2007 - 31st Oct 2008 6000 The 17-35s DNRers look 5000 to be a significant group 4000 Attendances 3000 2000 1000 0 0 - 5 5 - 10 11 - 16 17 - 35 36 -45 46 - 55 56 - 65 66 - 75 76+ 1639 1260 2221 4903 1978 1429 947 480 326 DNR R eferral S ource 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance by Town & Mileage - S elf R eferrals (DNR ) 1st Nov 2007 - 31st Oct 2008 3000 30 2500 25 2000 20 Attendance 1500 15 1000 10 500 5 0 0 R e s n y l h e n n g n k n e e s n h k e e t n e e e n k h h t r n o r N i a t a s c o n i n t o c c l a r n o r n d v t w l o o a l i t t o o o a e u r i s e s i l i o r r u v i t i r t w i r p o h s l r i i o b r h n n D r a m B k o a t o s W r n h n A o r i l c T s l b b F y n n o D n S t l l N g e m a c b S I s r i t r l w a a M i G l o a e l r y u i i s w k v K K e M a d u r l k A e M g k r e a s l S c C y r a D c l r N P o c i M A n K A o t - t B S o o n s M e n e n o n l r G W r N r a a a m m m l l i l K i K i K P ostcode 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran E mergency Access R eview A&E Attendance by Town & Mileage - Left Before Assessment (DNR ) 1st Nov 2007 - 31st Oct 2008 160 30 140 25 120 20 100 Attendance 80 15 60 10 40 5 20 0 0 R e s n l y h e n n g n k e n e s k n h e e t n e e e n k h h t r n N o r i a a s t c i o n n t c o c a l r n o r n v d t w l o o a l i t t o o o a e u r i s e i t l i o r r r u v i s r i w t i p o h r s l i i o b r h n n a m D r B k o t a o n s W r h n A o r i l c s T b l b n F y n o D t n S l l N g e m a c b S I s r i t r w l a a M i l G o a e r l y i u i s w v k K K e M d a u r l k A e M g k r e a s l c S C r y a D c l r N P o c i M A n K t A o - t B S o o n s M e n e n o n l r G W r N r a a a m m m l l i l K i K i K P ostcode 23/09/2009 B Samuel 2009

EADT Information Network 21 st May 2009 NHS Ayrshire & Arran Crosshouse Hospital A&E Attendance Review Stewart Cardwell Service Improvement Lead - Patient Access 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran - C rosshouse Hospital C omparison of Attendance by G ender 1st Nov 2007 - 31st Oct 2008 (64,206 Attendances) Female 29831, 46% Male 34375, 54% Over one year the split of male to female is 54% Male to 46% Female 23/09/2009 B Samuel 2009

NHS Ayrshire & Arran - C rosshouse Hospital A&E Attendance by G ender & Age G roup - Female 1st Nov 2007 - 31st Oct 2008 (29,831 Attendances) 10000 9000 The distribution of age groups 8000 showing the large numbers of 7000 17-35’s followed by 76+ Attendances 6000 5000 4000 3000 2000 1000 0 0 - 5 5 - 10 11 - 16 17 - 35 36 -45 46 - 55 56 - 65 66 - 75 76+ 2902 1394 2341 6921 3614 3095 2789 2720 4055 Female Age G roup 23/09/2009 B Samuel 2009