Seven Day Hospital Services Workshop: South East
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The document discusses the implementation and benefits of 7-day hospital services in the NHS, emphasizing the importance of accessibility to healthcare for patients at any time. It outlines progress towards achieving four priority standards aimed at improving patient experience, reducing mortality and hospital readmissions, and enhancing staff working conditions. Challenges in delivering these services across various trusts in the South East region are identified, along with strategies to overcome them and ensure equitable care for all patients.
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Seven Day Hospital Services Workshop: South East
- 1. Seven Day Hospital Services: South East Workshop 8th February 2018 WIFI Network: Park Plaza Victoria Password: No password
- 2. Welcome Dr. Rachael de Caux Regional Medical Director, South, NHS Improvement
- 3. Seven Day Hospital Services: Setting the scene Dr. Rachael de Caux Regional Medical Director, South, NHS Improvement
- 4. Overview 4 • 7 Day Services - the what and the why? • National and regional progress • Challenges identified across the SE identified by 7DS self-assessment gap analysis tool • Role of NHS Improvement & NHS England in supporting delivery • Questions
- 5. 7-day services – what they mean for patients “If I need to make an appointment to see or speak to a GP, I can get an evening or weekend appointment if I need to. My GP surgery offers a mix of face-to-face, telephone, email and video consultations.” “If I have an urgent need, I can phone or electronically contact NHS 111 and the NHS will arrange for me to see or speak to a GP or other health professional – any hour of the day and any day of the week.” “If I need to be admitted to hospital in an emergency, I will receive the same high quality of care any day of the week and any hour of the day. An experienced clinician will make timely decisions about my care and I will be able to access the services I need.” NHS 111 24/7 access to health advice “I can always get health advice from the NHS on my laptop, phone or through the internet.” 7-day community pharmacy “I can get health advice 7 days a week from a range of services, like pharmacy.” 7-day community support “If I need community support when I leave hospital, I can get this any day of the week” 5
- 6. 7-day hospital services: standards and outcomes 6 Patient involvement Time to consultant review* Multidisciplinary team review Shift handovers Access to diagnostics* Consultant-led interventions* Mental health Ongoing review* Transfers to other care environments Quality improvement 1 3 5 7 9 2 4 6 8 10 Reduced mortality for admitted patients Reduced length of stay Reduced readmission rates 10 clinical standards, of which four are national priorities … driving four main outcomes Four priority standards tracked to assess provider readiness Better patient experience Outcomes to be measured every six months
- 7. 7-day services: wider benefits Patient flow • Improving patient flow across the week and reducing spikes of activity, e.g. the ‘Monday morning’ effect • Improving A&E performance Asset utilisation • Making more effective and efficient use of equipment and theatres across the week, by avoiding decision traffic jams on Monday mornings NHS Improvement and NHS England are working with providers and local health economies to help ensure that implementation of 7-day services drives benefits across a number of areas Main outcomes • Reducing mortality • Reducing hospital readmissions • Reducing length of stay • Improving patient experience Working lives • Supporting greater flexibility in staff working patterns, eg through use of self-rostering • Enabling staff to take on enhanced roles 7
- 8. 7-day hospital services – the journey 8 By 2020-21, the four priority standards will be guaranteed for c.100% of the population (phase 3) By March 2017, the four priority standards will be guaranteed for 25% of the population (phase 1) By March 2018, the four priority standards will be guaranteed for 50% of the population (phase 2) 2016-17 2017-18 2018-19 2019-2025% 50% 100%
- 9. To meet these objectives, it is essential that all hospital providers and local health economies make sustained progress in each year from now to 2020. 9 Frimley Health Buckinghamshire Healthcare Oxford UH UH Southampton 2016-17 2017-18 2018-19 2019-2025% 50% 100% Although the timetable allows for different finishing points, this does not mean we are staggering the starting point Ashford & St. Peter’s Dartford & Gravesham Hampshire Hospitals Portsmouth Hospitals Royal Berkshire Queen Victoria H Surrey and Sussex Healthcare Western Sussex H Brighton & Sussex UH East Kent HU East Sussex Healthcare Isle of Wight Maidstone & TW Medway Royal Surrey CH
- 10. In the South East, a breakdown of performance by acute trust shows variation in performance with CS2, with 5 trusts below the national average of 71%. 10 Hospitals Sept 2017 March 2017 CS2 Trend CS2 CS2 CS5 CS6 CS8 A Decrease 62% 71% 100% 100% 86% B Decrease 94% 100% 94% 94% 97% C Decrease 87% 95% 100% 100% 92% D Increase 95% 64% 100% 100% 82% E No return No return 97% 100% 100% 92% F Decrease 79% 81% 100% 100% 91% G Decrease 62% 68% 100% 100% 91% H No return No return 74% 100% 100% 93% I Increase 72% 51% 86% 22% 100% J Decrease 55% 70% 87% 100% 87% K Decrease 67% 68% 97% 94% 94% L Increase 67% 66% 91% 94% 88%
- 11. www.england.nhs.uk A self- assessment readiness tool used included criteria in 5 domains: 1. Leadership and governance 2. Data capture and information quality 3. Performance and change management 4. Workforce readiness 5. Pathway policies and procedures There was an 83% response rate* *Note: 6 Trust’s were excluded from survey as they were were compliant or close to delivery in 2017. These included: Buckinghamshire Healthcare, Frimley Health, Oxford University Hospitals, University Hospital Southampton, Royal Bournemouth & Christchurch, Salisbury 11 In Summer 2017 acute Trusts across the South of England were asked to complete a 7DS gap analysis return Gap analysis tool returns
- 12. www.england.nhs.uk Across the South East, 50% of trusts reported there was no provision of a 12 hour Consultant present rota across the day 83% response rate. 14 out of 15 Trusts* in SE 77% report no ability to currently capture data electronically and 62% of Trusts did not validate 7DS survey data validation prior to submission. 58% report challenges with delivering Consultant daily ward/board rounds across a 7 day week and recording of delegation of Consultant review was a key challenge (67%) 58% of trust reported no 7DS delivery plan and 57% reported that 7DS not discussed across the system at the A/E Delivery Board. 50% do not have 12 hour Consultant presence rota across the day 43%% reported difficulties in creating a shared 7DS vision across the trust and challenges with clinical/ departmental ownership *Non returns of gap analysis – Hampshire Hospitals. Trusts close to /compliant with standards.were excluded
- 13. *Latest NHS Quality Account requirements request that providers of acute services are asked to include a statement regarding how they are implementing the priority clinical standards for seven day hospital services. https://improvement.nhs.uk/news-alerts/provider- bulletin-31-january-18/#quality-accounts-requirements Improvement Support Sustainability and Transform- ation Partnerships NHS Planning Guidance CCG Improvement and Assessment Framework Improvemen t Support NHS Standard Contract Quality account Requirements * CQC Inspection Framework There are many levers to support the delivery of 7 day services with partners
- 14. Support for 7 day services in region 14 Regional Programme Leads Sue Cottle SI NHSE [email protected] Charlotte Wood NHSI [email protected] South East SI Team Sue Cottle Wendy Keating Delivery planning Enabling system wide conversations Communicating between the trusts and the ALBs Helping with the ‘how to’ Supporting measurement
- 16. 7 Day Hospital Services: National Learning to date Dr. Arrash Arya Yassaee Clinical Fellow, NHS Improvement [email protected]
- 17. 7 day services in hospitals - milestones 17 April 2017 25% April 2018 50% 2018/19 April 2020 100% By April 2017, the four priority standards available to 25% of the population By April 2018, the four priority standards available to 50% of the population By 2020/21, the four priority standards available to 100% of the population
- 18. Regional learning events 18 North 95 attendees 38 organisations Mids & East (1) 42 attendees 21 organisations London 57 attendees 19 organisations South 89 attendees 40+ organisations Mids & East (2) 37 attendees 19 organisations
- 19. Preliminary Learning 19 What trusts will now do differently: • “Simplify admissions process, unified clerking pro forma” • “Friday ward round sheet – identify those need to be seen” • “Explore the idea of perioperative practitioners” • “review capturing electronically and setting count downs on assessment standard 2” What support can we provide them: • “an evidence base from Trusts employing various interventions and even better, ‘off the shelf’ business cases for each” • “provide clearer guidance on the standards, with examples or case studies to illustrate” • “Explain core standards to trust members; support us with engagement events”
- 20. 7 day services in hospitals: challenges 20 Workforce Reconfiguration & Networks Communications & Engagement
- 21. Learning document 21 Key themes: • Understanding and Implementing Clinical Standard 2 • Job planning • Winning hearts and minds • Clinical Handover • Workforce constraints • Reconfiguring and networking services https://improvement.nhs.uk/uploads/documents/Seven_day_hospital_services_challenges_and_solutions_FINAL_3.pdf
- 22. 22 Understanding and implementing Clinical Standard 2 • Trusts should refer to the Seven Day Services Clinical Standards – updated September 2017. • Providers and commissioners can make local decisions on how to confirm with the guidance – this could include: • increasing the number of formal protocol pathways in operation • cross-cover arrangements between subspecialties • network solutions • Consultant review offers clinical benefit to the patient but also helps ration investigations and facilitate discharge. • Risk stratification and prioritisation tools (including electronic solutions) help provide real-time data and decision-making support to achieve CS2. • Systems-level approaches (e.g. care home visits, changing GP visit times etc) have helped reduce demand on acute centres.
- 23. 23 Job planning • Job plans should reflect shared objectives and job planning processes should align with trust’s business planning process. • Several hospitals have operated various solutions in increase OOH consultant presence: • Designating a set number of PAs for OOH care for all newly appointed consultants. • Appointing consultant leads for OOH care. • Integrating weekend discharge team responsibilities in consultant job plans. • Involving other health professionals in consultant job planning process helps identify tasks that other members of the MDT can do. • New roles with clearly defined job descriptions can free up clinical time of senior staff: • Medical support workers • Therapy assistants (to improve PT/OT capacity)
- 24. 24 Handover and workforce constraints • Several trusts discussed how they improved handover of clinical care as well as the capacity of their staff: • Easily accessible information on referral pathways, OOH services and guidelines. • CCG-level single agreed assessment-for-discharge process. • Weekend handover sheets with clear instructions of weekend plan (including suggested action, escalation plan, grade of doctor needed to review patient) can benefit both clinical team and for subsequent audit. • A number of trusts have increased use of ambulatory care pathways with up to 50% of surgical patients and up to 30% of medical patient managed in this way.
- 25. Next steps (1) – upcoming projects Documentation review Use of protocols and pathways Expediting consultant review in AMU
- 26. Next steps (2) – Detailed case studies Reconfiguration & Networks New clinical roles Use of technology New patterns of working Financial case studies
- 27. Questions? 27
- 28. Refreshment break WIFI Network: Royal Plaza Victoria No Password
- 29. Workshop One - Delegation of consultant reviews and clinical handover strategies: sharing successes and challenges
- 30. Workshop One - Delegation of consultant reviews and clinical handover strategies: 30 Step 1: Talk through one example of a patient pathway (eg medicine, surgery, T&O, care of the elderly – Consultant directed/ delegated or non-consultant protocol) Step 2: How have you engaged staff/approached the pathway to improve CS2 and CS8 achievement? Step 3: What were the hurdles? How did you overcome them? GROUP FEEDBACK – 10 mins One practical step that you feel would be useful to take forward
- 31. Lunch and networking WIFI Network: Park Plaza Victoria No Password
- 32. Our journey to date: challenges and solutions Constantinos Yiangou, Associate Medical Director and Seven Day Services Lead, Portsmouth Hospitals NHS Trust
- 33. Page 33 3/6/2018
- 34. National Seven Day Services Surveys Table 1: Patients audited (sample of emergency admissions) SURVEY Weekday Saturday Sunday TOTAL Spring 2016 189 21 33 243 Autumn 2016 145 24 25 194 Spring 2017 146 17 26 189 Autumn 2017 141 30 29 200
- 35. Clinical Standard Two Table 2: Patients seen within 14 hours from admission by a consultant SURVEY Weekday Weekend Saturday Sunday Spring 2016* 68.3% 78% 81% 75.8% Autumn 2016 66% 67% 72% 64% Spring 2017 84% 77% 82% 73% Autumn 2017 77% 83% 77% 90% *for this survey the arrival time was used
- 36. Clinical Standard Two – Autumn 2016 Chart 1: Proportion of patients who received a first consultant review within 14 hours of arrival to hospital
- 37. Clinical Standard Two – Spring 2017 Chart 2: Proportion of patients who received a first consultant review within 14 hours of admission to hospital
- 38. Clinical Standard Two Table 3: Documented evidence that patients/families/carers informed within 48 hours of diagnosis/treatment plan SURVEY Weekday Weekend Saturday Sunday Spring 2016 49.7% 52% 61.9% 45.5% Autumn 2016 76% 73% 94% 59% Spring 2017 95% 74% 65% 81% Autumn 2017 52% 71% 67% 76%
- 39. Clinical Standard Five Diagnostics – fully compliant • CT Scan • Microbiology • Echocardiography • Upper GI – Endoscopy • MRI scan * • US Scan *Indications for out of hours use are spinal cord compression and cauda equina syndrome
- 40. Clinical Standard Six Consultant-directed interventions – fully compliant • Critical care • Primary PCI • Cardiac pacing • Thrombolysis for stroke • Emergency general surgery • Interventional endoscopy • Interventional radiology* • Renal replacement • Urgent radiotherapy
- 41. Clinical Standard Eight Table 4. Ongoing once daily review of inpatients by a Consultant or an appropriate delegate SURVEY Weekday Weekend Saturday Sunday Spring 2016 67.6% 67% 50% 75% Autumn 2016 99% 98% 92% 95% Spring 2017 95% 81% 83% 79%
- 42. Clinical Standard Eight – Spring 2017 Chart 3: Proportion of once daily Consultant reviews (or delegated)
- 43. Clinical Standard Two – Autumn 2016 Chart 4: Cumulative hours between admission and 1st consultant review
- 44. Clinical Standard Two – Spring 2017 Chart 5: Cumulative hours between admission and 1st consultant review
- 45. Clinical Standard Two – Autumn 2017 Chart 6: Cumulative hours between admission and 1st consultant review
- 46. 3/6/2018 Clinical Standard Two Table 5: Emergency patients seen within 14 hours from admission in the eight busiest specialties (N: number of admitted patients; %: percentage seen by a Consultant within 14 hours Specialty Spring 2017 Autumn 2017 Weekday Weekend Weekday Weekend N % N % N % N % Acute internal medicine 58 95 14 86 57 89 27 93 Cardiology 3 100 2 50 9 78 8 88 General Surgery 10 70 6 67 16 69 1 100 Geriatric Medicine 19 68 5 80 22 64 7 71 Oncology 4 50 0 N/A 6 83 2 50 Paediatrics 12 67 3 67 8 38 4 50 Stroke Medicine 9 67 2 0 9 78 4 75 Trauma and Orthopaedics 23 96 6 100 4 100 3 100
- 47. Summary • Strong clinical involvement • Improvement in some specialties (clinical standards 2 and 8) • Diagnostics and interventions – no issues • Performance similar throughout the week • Benchmarking data encouraging • 14-hour threshold missed by 2-3 hours
- 48. Challenges/Solutions • Documentation – electronic? • Protocols for standard presentations • Allocation of additional resource to unscheduled care – “medical model” and surgeon of the week • Outliers – bed reconfiguration, cohorting patients • Appropriate delegation – board rounds • Handover lists – electronic? • The late afternoon/early evening admissions – evening ward rounds • Job planning and the impact on scheduled care
- 49. PHT Medical Model - 1 • The medical model commenced in earnest on Sept 4th 2017. • The model supports the delivery of a 7-day per week 08.00-22.00hrs consultant led medical take. • The model has supported safer care of medical pts in ED and the emergency corridor, particularly OOH with extended senior cover.
- 50. PHT Medical Model - 2 • Work is effectively identified and tracked using the AMU Take List on BedView allowing those individuals and teams participating in the take to be able to see which patients are already being reviewed by another team and which patients still need to be seen. TAKE LIST Patient level data entry
- 51. PHT Medical Model - 3 • We are tracking data daily data from BedView demonstrating the percentage of pts having a consultant review within 14 hours, with a weekly data update. • Medical take trend line below shows continued improvement from 67% of pts having a consultant review within 14 hours before medical model to 86% by 21.01.18
- 52. Questions? 52
- 53. Our journey to date: challenges and solutions Roger Duckitt, Clinical Lead – Acute Medicine, Western Sussex Hospitals NHS Foundation Trust
- 54. Western Sussex Hospitals NHS Foundation Trust 7DS National Survey - Progress Overview – February 2018
- 55. 55 WSHFT Headlines from Self Assessment – October 2017 The Results have remained static from the last self assessment in the Spring 2017. WSHFT Trust wide Baseline: Proportion of patients reviewed by a consultant within 14 hours of admission at hospital September 2016 March 2017 October 2017 50% 68% 66% October 2017 Results Split by Site Sample Number Suitable consultant review within 14 hours of ADMISSION % compliance Worthing 122 80 66% St Richard’s 123 82 67% Overall 245 162 66%
- 56. 56 WSHFT Headlines from Self Assessment – October 2017 The Results have remained static from the last self assessment in the Spring 2017. WSHFT Trust wide Baseline: Proportion of patients reviewed by a consultant within 14 hours of admission at hospital September 2016 March 2017 October 2017 50% 68% 66% October 2017 Results Split by Site Sample Number Suitable consultant review within 14 hours of ADMISSION % compliance Worthing 122 80 66% St Richard’s 123 82 67% Overall 245 162 66% <1% of total admissions
- 57. 57 Standard 2: Time to 1st Consultant
- 58. 58 Standard 2 - (Day of Admission)
- 59. 59 Standard 2 (Compliance by Speciality) St Richards Hospital
- 60. 60 Standard 2 (Compliance by Speciality) Worthing Hospital
- 61. 61 Key Challenges • Sample size small • Wide variation • Weekends! • Manual notes reviews • Data collection • Staffing and processes
- 62. 62 Seven Day Services 2018/19 - Next Steps • Divisions Service Prioritisation 2018/19 to include 7DS • Restructure of medical rotas to meet compliance ahead of 2020 • Quality and depth of data to be improved • Use data available to establish areas of focus • Seven Day services as Trust Corporate Project
- 63. 63 Divisional Prioritisation – Chiefs of Service
- 67. 67 WSHFT – What have we tried? General Surgery / Medicine / Elderly Care • Technical / Data collection • Staffing / Rota changes
- 68. 68 WSHFT – Data Collection and Reporting • e-Whiteboard (2003) • Emergency Floor admissions dashboard • 7DS Dashboard • e-Handover (update due 2018)
- 69. 69 e-Whiteboard
- 70. 70 e-Whiteboard
- 71. 71 e-Whiteboard • Currently Medicine, DOME, General Surgery, Urology, T&O • Compliance is the key obstacle
- 72. 72 e-Whiteboard • Currently Medicine, DOME, General Surgery, Urology, T&O • Compliance is the key obstacle 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% %PatientswithDocumentedReview Mean Control Limits (+/- 3s) +/- 1s +/- 2s Time Stamped ConsultantReview Worthing Surgery
- 73. 73 e-Whiteboard • Currently Medicine, DOME, General Surgery, Urology, T&O • Compliance is the key obstacle 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% %PatientswithDocumentedReview Mean Control Limits (+/- 3s) +/- 1s +/- 2s Time Stamped ConsultantReview St. Richard'sMedicine
- 74. 74 e-Whiteboard • Currently Medicine, DOME, General Surgery, Urology, T&O • Compliance is the key obstacle 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% %PatientswithDocumentedReview Mean Control Limits (+/- 3s) +/- 1s +/- 2s Time Stamped ConsultantReview Worthing Medicine + DOME
- 81. 7DS Dashboard
- 82. Rota modifications • AIM Cons. – increase daily cover to 7pm (Worthing) • AIM Cons. – Twilight Shift to 8pm - weekdays (SRH) • AIM/GIM split – 365 cover to 7pm (Worthing) • DOME Consultants off rota – 5-7pm Twilight shift • Surgical Consultants – no change
- 83. Impact of rota modifications Twilights 20% Consultant review documented – Arrivals from 08:00 – 19:00 - MEDICINE
- 84. Impact of rota modifications Weekends 20% 60%
- 85. Impact of rota change: Medicine 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 13/04/2014 13/05/2014 13/06/2014 13/07/2014 13/08/2014 13/09/2014 13/10/2014 13/11/2014 13/12/2014 13/01/2015 13/02/2015 13/03/2015 13/04/2015 13/05/2015 13/06/2015 13/07/2015 13/08/2015 13/09/2015 13/10/2015 13/11/2015 13/12/2015 13/01/2016 13/02/2016 13/03/2016 13/04/2016 13/05/2016 13/06/2016 13/07/2016 13/08/2016 13/09/2016 13/10/2016 13/11/2016 13/12/2016 13/01/2017 Percentage Patients with Documented Under 14 Hour Review - Worthing Medicine DOME Surgery
- 86. Impact of rota change - DOME
- 87. 87 Key Themes and Challenges • Weekend variation • impact of extended hours ?how to achieve cross-site • Surgical performance • Assess change in mechanism for data collection • re-organisation of junior support to PTWR • ‘Evening Patients’ – seen after night-patients on PTWR • RCA/deep dives to explore breaches once compliance >90%
- 88. 88 Next Steps? • Weekend variation • impact of extended hours ?how to achieve cross-site • Surgical performance • Assess change in mechanism for data collection • re-organisation of junior support to PTWR • ‘Evening Patients’ – seen after night-patients on PTWR • RCA/deep dives to explore breaches once compliance >90% • Standard 8…
- 89. 89 Questions?
- 90. Refreshment break WIFI Network: Royal Plaza Victoria No Password
- 91. Workshop Two – Acting on survey results, staff engagement: sharing successes and challenges
- 92. Workshop Two – Acting on survey results, staff engagement: sharing successes and challenges 92 Each Trust to discuss – 10 minutes each Q1. What are you doing with your survey results? How are you sharing information with staff? Q2. Where have you seen improvements and why? Where are you still seeing challenges? GROUP FEEDBACK – 10 mins One practical step that you feel would be useful to take forward
- 93. What have we heard Feeding back from group workshops
- 94. Next Steps
- 95. Close Thank You For Attending