Thank you to all my colleagues here at The Countess continuing to pull out all the stops to get behind our plans and arrangements to be as ready as we can be for winter. I do know how hard it is. This week it is our care of the elderly consultant and Clinical Director for Emergency Medicine Kausik Chatterjee, who has stopped us all in our tracks. He has done a detailed piece of work reviewing a sample of case notes of Emergency Department attendances between January 2016 and October 2016. The presentation of Kausik’s findings around breaches of the four hour access target within the hospital is both helpful and frustrating at the same time. If you see him walking the corridors of The Countess, please do ask him about it. Below are some reflections, assumptions, observations (or whatever you want to call them) that may or may not be familiar to you…
1. We see the highest number of breaches mid-week and the lowest number of breaches on a Friday. A patient is more likely to breach if attending between 10pm and 6am.
2. The four hour breaches in the sample reviewed mostly happened to patients treated in what we call ‘majors’ - the 13-trolley unit where the sickest of our patients go for assessment.
3. Of those breaching 44% are attributed to a delay in being seen by a clinician (particularly a night time issue), 31% due to bed waits (a daytime issue) and 17% attributed to Emergency Department capacity (cubicle availability).
4. Bed demand starts being an issue at 10am through to 8pm while we await discharges. It picks up late Sunday and continues to rise throughout Monday and Tuesday.
5. Up to 38% of Countess emergency department attendances could have been avoided or seen in an alternative healthcare setting. The national average is about 25%. This means 1 in 3 patients could have been dealt with differently – either through 111, GP out of hours or a daytime GP appointment.
6. Examples of what the emergency department team are dealing with in the case notes reviewed as part of this exercise includes:
o Elderly parent brought in for a check-up ahead of family going on holiday
o A woman calling in to request that her contraceptive implant is removed
o A person with worsening knee pain sent by their GP to ask for crutches
o Requests to deal with infected toe and thumb nails
o An individual needing stitches removed
o A person that has had a two-day headache
o A request to check an ear, in case a cotton bud was left in it earlier in the week
o A parent looking for advice regarding possible chicken pox in their child
o Repeat attendees from people living with dementia, brought in by a concerned friend or relative worried about leaving them alone at home
Surely there must be even more that we and our system healthcare partners can do differently?
There is no doubt in my mind that we will continue to be tested and pushed to our limits in the weeks ahead. Despite regional Sustainability and Transformation Plans dominating the local headlines, here at The Countess there remains an abundance of frontline NHS energy, innovation and goodwill to give ourselves a head start and a fighting chance as December descends. So far this month we have seen an improvement in performance. We even achieved 95% of patients being seen within four hours this week – our position among acute providers shifting from 120th to 3rd best performer in the country.
It is our strongest performance for a long time, as well as a much needed boost for morale and our belief that we can do this, we can make a difference. And the ideas keep coming. Our latest plans see us welcoming GP out of hours services to trial overnight work from the main hospital site later this month, we have reviewed our escalation policy and we have new ‘transfer teams’ in place to support the speed with which patients are moved around the hospital. We’ve been running bed meetings every two hours, and had Emergency Department matron Jo Windsor working full time on the shop floor. Meanwhile changes we have made to radiography services, co-locating consultant radiologists in a new ‘hot room’ facility have also generated much local interest this week. Our turnaround times for reports on scans and x-rays are vastly improved.
Every day, I see examples of a team doing all that it can to find faster, more effective ways of working.
As your Chief Executive, I cannot ask for anymore. Thank you once again.
With best wishes, Tony Chambers