Emergency Department Progress Report for Health Scrutiny Senior - PDF document

Introduction Emergency Department Progress Report for Health Scrutiny • Senior Emergency Medicine Clinicians • Middle Grade Doctors 27 June 2012 • Nurse Staffing • Patient Experience Chris Holt – Deputy Chief Operating Officer Dr Bob Coupe – Clinical Lead for Emergency Medicine Middle Grade Doctors Senior Emergency Medicine Clinicians Criteria: 5 Substantive Senior Emergency Medicine Clinicians (or Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least confirmed start dates) 5 substantive and the remainder on fixed term contracts – Dr Terri Bentley , on Specialist Register, commenced 1 st December 2008, – Currently 4 Substantive Middle Grade Doctors: Appointed as Clinical Lead March 2012 – Dr Bob Coupe , not currently on Specialist Register, commenced 26 th January - Dr Anca Angelescu , commenced MSFT 5/10/10 2012 – Appointed as Clinical Lead March 2012 - Dr Mariel Bruzzo , commenced MSFT 6/12/10 – Dr Rebecca Race , on Specialist Register, commenced 31 st January 2012 - Dr Satya Khare , commenced MSFT 5/12/11 – Dr Dilip Da-Cruz , on Specialist Register, commenced 15 th February 2012 - Dr Muhammad Nagori , commenced MSFT 21/3/12 – Dr Venkat Kodamanchali , Middle Grade Specialty Doctor, Acting Consultant, commenced August 2010 (as MGSD 16 th October 1996) - All permanent appointments – One vacant post out to advert, closing date 22 June. 2 applicants shortlisting taking place potential date for interview 19th July Middle Grade Doctors Middle Grade Doctors Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at least 5 substantive and the remainder on fixed term contracts least 5 substantive and the remainder on fixed term contracts Current 4 Appointed Middle Grade Doctors to join: Current Long Term Agency Locum Middle Grade Doctors : Dr Musunuru appointed May 2012 commences 1 st November 2012 – – 3 Long term agency locums all on 6 month contracts – Dr Zarroug appointed May 2012 awaiting restricted work permit (currently outside the UK) – Dr Hamzat: working with MSFT since September 2011 – Dr Thakur appointed March 2012 awaiting restricted work permit (currently – Dr Iqbal: working within MSFT since December 2011 working in UK) – Dr Ya contractual negotiations being finalised (currently working in the UK on a – Dr Yasin: working with MSFT since December 2011 restricted work permit) – All permanent appointments

Middle Grade Doctors Middle Grade Doctors Criteria: All Middle Grade Doctors to be suitably qualified in Advanced Life Criteria: 7 Middle Grade Doctors (from an establishment of 9) with at Support, Advanced Paediatric Life Support (100% qualified) and least 5 substantive and the remainder on fixed term contracts Advanced Trauma Life Support (min 3 qualified with remainder with dates booked) Overview of Middle Grade Doctors Middle Grade ALS APLS / EPLS ATLS Jun’12 Oct’12 Trust MG 1 Passed Passed Passed Trust MG 2 Passed Passed Passed Appointed 4 0 Trust MG 2 Passed Passed Passed Permanent 4 8 Trust MG 2 Passed Booked 27/28 Sept‘12 Passed Long term locums 3 1 Locum 1 Passed To be booked Passed Locum 2 Passed To be booked Passed TOTAL IN POST 7 9 Locum 3 Passed To be booked Complete Jun’12 Middle Grade Doctors Senior Nurse Staffing Criteria: All Middle Grade Doctors assessed (internal work based assessment) as competent to manage the department at night Criteria: 1 WTE appointment of Emergency Care Matron • Teaching programme continues every week in relation to clinical 4.4 WTE appointment of Band 7 Nurses in post competencies • Matron attended staff induction in June and will start in the • All will be assessed with an Observed Skills Clinical Examination department on 2 nd July June ’12. • All clinical competencies to be signed off by the Consultants by 17 • 4.4 WTE Band 7 nurses have been appointed – 1.6 WTE acting up July. posts on a temporary basis – all will be in post July 2012 • Ongoing observation and shop floor assessment to confirm their competency to manage the dept overnight • Shop floor management assessment of substantive and locum middle grade doctors to be completed by mid-late July Nurse Staffing Nurse Staffing Criteria: Nursing workforce to be at 90% establishment • Establishment is 56.30 WTE across Trained and HCSW workforce • Overall nursing workforce at 93.20% as of June 2012 • Bespoke recruitment and induction programme in place • 3 Staff Nurses commenced in June Overview of Nursing Workforce • 1 Staff Nurses due to commence in July and another in O ctober Jun’12 Oct’12 Interviews for Band 5 Staff Nurses on 5 th and 6th July • WTE % WTE % In Post 52.47 93.20% 56.30 100% • Based on recent recruitment and recent staff turnover the predicted establishment will be at 90% therefore if suitable Appointed 2.6 4.6% 0 0 candidates are identified in July interviews they will be recruited into Band 5 posts Total 55.07 97.8% 56.30 100%

Nurse Staffing Nurse Capabilities and Training • The table below shows the A&E turnover rates for trained nursing staff between August 2011 and April 2012 • ~30% of the workforce will have been replaced by Oct 2012 • Criteria: Nurses’ competencies to be In Post Leavers Month Headcount WTE H/Count WTE Turnover % monitored Aug’11 50 43.94 1 0.96 2.00% Nov’11 49 42.48 1 1.00 2.04% Dec’11 46 40.08 3 2.52 6.52% Jan’12 45 39.08 1 1.00 2.22% Feb’12 44 38.29 1 0.80 2.27% Mar’12 44 38.29 1 1.00 2.27% Apr’12 40 34.36 3 3.00 7.50% May’12 47 39.56 1 .60 2.12% June’12 50 41.96 2 1.6 4% July’12 50 41.96 1 1 2% Oct’12 51 45.19 TOTAL 51 15 ~30% Patient Experience Patient Experience Attendances since closure Date Attendance Breach % 1 st Dec’10 to 1 st 21,808 4790 78.04 May’11 1 st Dec’11 to 1 st 18,013 2025 88.76 May’12 Diff Down 3,795 Down 2,765 MSFT Attendance Profile MSFT Attendance Profile Total A&E Attendances versus Major Attendances between 3rd October 2011 and 6th May 2012 • Attendance split since the closure indicates 55% 1200 majors v 45% minors 1100 OOH’s closure of A&E 1000 900 • National patient mix is ~25% majors v 75% minors, 800 700 Attendances meaning the % number of breaches on a complex Drop in attendances from OOH’s closure 600 predominantly in Minors stream case mix is encouraging 500 400 300 200 • We are also experiencing the same number of No. of majors patients remained static 100 despite closure overnight for 10 hours majors previously seen within a 24hr period in 14 0 9/10/2011 16/10/2011 23/10/2011 30/10/2011 6/11/2011 13/11/2011 20/11/2011 27/11/2011 4/12/2011 11/12/2011 18/12/2011 25/12/2011 1/1/2012 8/1/2012 15/1/2012 22/1/2012 29/1/2012 5/2/2012 12/2/2012 19/2/2012 26/2/2012 4/3/2012 11/3/2012 18/3/2012 25/3/2012 1/4/2012 8/4/2012 15/4/2012 22/4/2012 29/4/2012 6/5/2012 hours Week Ending Total Attendances Major Attendances

MSFT Performance MSFT Performance A&E 4hr Wait Performance MSFT performance consistently above Criteria: Achievement of 4hr access target for 95% of patient attendances national average since March’12 100.0 Quarter Month / Week Attends Breaches % 95.0 Jan’12 3545 759 78.39% Feb’12 3402 610 82.07% Q4 11/12 90.0 Mar’12 3955 155 96.08% Q4’12 % 85.0 Apr’12 3635 176 95.16% May’12 4029 323 91.98% 80.0 04/06 878 46 94.76% Q1 12/13 June’12 11/06 958 28 97.08% 75.0 (to date) 18/06 918 34 96.30% Q1’12 to date 3248 138 95.75% 70.0 National Average (%) MSFT (%) BURTON (%) UHNS (%) Hospital Flow / Discharges - Hospital Flow / Discharges Criteria: Weekend discharges to be 60% of average weekly discharges Criteria: 30% of all daily discharges from medical wards by 11am Target = 15 Ward No. of Patients Discharged Based patients 16 14 12 s t n 10 e i t a P 8 f o . 6 o N 4 2 0 Long Stay Patients Summary Criteria: To decrease the No. of Long Stay patients to <50 • Overall good progress on – recruitment of staff Overall Summary – competency development of staff 140 45 – achievement of 4 hour emergency access target 40 120 – development of a new team with aspirations to be high performing 35 100 – Weekly performance review with acute care physicians around 30 patient flow indicators Avg LOS (days) # of Patients 80 25 20 60 • Progress still to be made 15 40 – ED team need to consolidate their skills and new staff members 10 need time to settle into the team 20 5 – Downstream work streams need to gather pace and deliver on 0 0 07/02/2011 14/02/2011 21/02/2011 14/03/2011 21/03/2011 08/04/2011 14/04/2011 21/04/2011 03/05/2011 11/05/2011 12/05/2011 17/05/2011 18/05/2011 25/05/2011 31/05/2011 16/06/2011 21/06/2011 29/06/2011 06/07/2011 14/07/2011 27/07/2011 03/08/2011 10/08/2011 17/08/2011 24/08/2011 31/08/2011 07/09/2011 14/09/2011 20/09/2011 28/09/2011 05/10/2011 12/10/2011 19/10/2011 26/10/2011 02/11/2011 09/11/2011 16/11/2011 23/11/2011 30/11/2011 07/12/2011 14/12/2011 21/12/2011 04/01/2012 11/01/2012 18/01/2012 25/01/2012 01/02/2012 08/02/2012 15/02/2012 22/02/2012 29/02/2012 14/03/2012 21/03/2012 28/03/2012 04/04/2012 11/04/2012 18/04/2012 25/04/2012 09/05/2012 16/05/2012 23/05/2012 30/05/2012 07/06/2012 13/06/2012 trajectories No. of Patien ts Average of LOS