Supported by & delivering for:
London’s NHS organisations include all of London’s CCGs, NHS Engl& & Health Education Engl&
Intro to 4th
collaborative event
Shifting the curve to the left
Driving Improvement with data
1
Derek Bell
Data we have collected so far..
House icon by Xinh Studio for Noun Project; Hospital icon by Mikicon for Noun Project; Person by asiansondesign for Noun Project
Pre-hospital In-hospital Out-of-hospital
4hr curve
HospitalA:
54%UCCreferralsbreachinED
57%UCCbreachesarenon-adm
HospitalB:
57%UCCreferralsbreachinED
63%UCCbreachesarenon-adm
HospitalA
HospitalB
UCC/ED transfer Admitted &
non-admitted flow
119
127
132
181
214
288
0 50 100 150 200 250 300 350
Wai ngfundingforplacement,vacancyincarehome
Awai ngcommunityhospitalbed
Awai ngprocedure/inves ga on/resultsandnotmee ngcriteriaforacutecare
Awai ngconsultantdecision/review
Wai ngforAHPassessment/treatment
Awai ngsocialworkalloca on/assessment/comple onofassessment
Top6reasonspa entswerenotdischarged
Day-of-Care survey
DelayedTransferofCareDTOCrateover me:MentalHealthTrustX
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Apr-14
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Oct-16
Dec-16
Feb-17
Apr-17
Jun-17
DTO
Crate
DTOCrate
Average
LowerControlLimit
UpperControlLimit
Delayed transfers
of care
3
Automated 4hr performance over time using publicly available data will soon be
available online for all trusts to use
London performance
4
London attendances
Need for London to focus on BOTH admitted & non-
admitted flow
5
Non-admitted
flow 87.5% 4hr
performance:
this is
important
6
1. Early triage (within 15 minutes)
2. Senior review/treatment within 1 hour
3. Aim discharge within 2-2.5 hours instead of 4hrs
AIMS:
Non-admitted flow: UCC/ED transfer data
Hospital A:
• 54% UCC referrals
breach in ED
• 57% UCC breaches are
non-admitted
• Paediatric breached
Hospital B:
• 57% UCC referrals
breach in ED
• 63% UCC breaches are
non-admitted
Hospital A
Hospital B
Admitted flow: Shifting the curve to the left -
understanding the themes
7
Needtoshi thiscurvetothele
16hrs.
Shift the curve: IN DAY Shift the curve: ENTIRE
JOURNEY
Discharge
lounge
Ambulatory
care
Acute medical
units
Focus of upcoming collaborative actions to shift the curve:
Day of Care survey (DoCS) showed 24% of patients
in hospital do not meet criteria for acute care
8
DoCS shows delays across entire patient journey
9
325
2194
12911003
1205
30
315
282
394
901
0
500
1000
1500
2000
2500
3000
0 1to3 4to7 8to14 over14
Numberofpa
ents
Lengthofstaybands,days
Lengthofstayforallpa entswhometanddidnotmeetDoCScriteria
DoCScriterianotmet
DoCScriteriamet
146
821
3346
1599
50
136
1349
409
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Emergencyservices Acuteservices Medicine Surgery
Numberofpa
ents
Groupwardtype
Totalnumberofpa entswhometanddidnotmeetcriteriabygroupwardtype
Notmet
Met
• 1-3 days most common LOS
• High proportion in 1 to 3 days
not meeting criteria
• LOS over 14 days has most
number of patients not meeting
criteria: 47%
• Number of patients not meeting
criteria increasing with age
• Medicine beds = 60% of
inpatient population
• Medicine group has largest
number of patients not meeting
criteria: (69%)
• 49% of patients in medicine
beds who do not meet criteria
are in
elderly/frailty/stroke/rehab
Winter signs can be seen earlier that we think..
10
• Increase in
number of
respiratory
episodes of care
since 22nd
October
• 4 hour
performance
decline only
started beginning
of December
Flu vaccine
absolutely crucial
to avoid winter
decline
