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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”