Frailty Capacity Modelling in West Lothian

Neil Pettinger / 21 April 2015

A&E

AssessmentA&E

WardsAssessmentA&E

HomecareWardsAssessmentA&E

How many?

HomecareWardsAssessmentA&E

Howlong?

How many?

HomecareWardsAssessmentA&E

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

148attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

151minutes

148attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

148attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

148attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

148attendances

29hours

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

148attendances

29hours

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

26admissions

148attendances

29hours

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.This to fit into a bed

complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

26admissions

148attendances

6.1days

29hours

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.This to fit into a bed

complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

26admissions

148attendances

6.1days

29hours

157patients

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.This to fit into a bed

complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014: Boarding Levels

Ward

Ave no of beds occupied by medical

inpatients in 2014 Bed Complement Ave % bed occupancySJH08 28.9 30 96.4%SJH08A 0.3SJH09 28.8 30 96.0%SJH11 0.0SJH12 2.5SJH14 4.2SJH15 3.9SJH17 0.0SJH18 3.4SJH19A 1.9SJH21 29.1 30 96.9%SJH25 24.1 24 100.3%SJH25W 6.1 6 101.0%SJHBURNS 0.0SJHDIS 1.3SJHDOSA 0.0SJHDSC 0.1SJHEND 0.0SJHITU 0.0SJHOU 0.0SJHOW 1.6SJHREDU 0.0SJHSU 20.9 22 94.8%TOTAL 157.0 142.0 110.6%

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29hours

157patients

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29hours

75minutes

157patients

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29hours

75minutes

157patients

33patients

2,125hours

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

1,700service users

26admissions

26admissions

148attendances

6.1days

29hours

75minutes

157patients

33patients

2,125hours

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.

Homecare data comprises “round number estimates” based on conversations with Yvonne Lawton and Rachel MacKay.

This to fit into a bed complement of 36 + an

element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

Calendar Year 2014 / Four-hour compliance: 94.6%

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014: Boarding Levels

Ward

Ave no of beds occupied by medical

inpatients in 2014 Bed Complement Ave % bed occupancySJH08 28.9 30 96.4%SJH08A 0.3SJH09 28.8 30 96.0%SJH11 0.0SJH12 2.5SJH14 4.2SJH15 3.9SJH17 0.0SJH18 3.4SJH19A 1.9SJH21 29.1 30 96.9%SJH25 24.1 24 100.3%SJH25W 6.1 6 101.0%SJHBURNS 0.0SJHDIS 1.3SJHDOSA 0.0SJHDSC 0.1SJHEND 0.0SJHITU 0.0SJHOU 0.0SJHOW 1.6SJHREDU 0.0SJHSU 20.9 22 94.8%TOTAL 157.0 142.0 110.6%

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

168minutes

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

168minutes

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

138minutes

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

138minutes

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

30hours

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

30hours

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

29hours

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

29hours

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

151attendances

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

26admissions

142attendances

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

25admissions

26admissions

142attendances

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

6.3days

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

25admissions

26admissions

142attendances

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

6.3days

30hours

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

25admissions

26admissions

142attendances

6.2days

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

6.3days

30hours

160patients

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

25admissions

26admissions

142attendances

6.2days

29hours

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

18patients

168minutes

27admissions

27admissions

151attendances

6.3days

30hours

160patients

34patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / COMPARE AND CONTRAST

Howfull?

Howlong?

How many?

Post AcuteWardsAssessmentA&E

14patients

138minutes

25admissions

26admissions

142attendances

6.2days

29hours

155patients

32patients

“Worst” 91 days of 2014 (88% compliance) “Best” 91 days of 2014 (99% compliance)

NHS LOTHIAN | ST JOHN'S HOSPITAL | CALENDAR YEAR 2014

120

130

140

150

160

170

180

190

200

1-Jan

15-Jan

29-Jan

12-Feb

26-Feb

12-Mar

26-Mar

9-Apr

23-Apr

7-May

21-May

4-Jun

18-Jun

2-Jul

16-Jul

30-Jul

13-Aug

27-Aug

10-Sep

24-Sep

8-Oct

22-Oct

5-Nov

19-Nov

3-Dec

17-Dec

31-Dec

Date

No

. of

bed

s o

ccu

pie

dSt John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, calendar year 2014

NHS LOTHIAN | ST JOHN'S HOSPITAL | CALENDAR YEAR 2014

120

130

140

150

160

170

180

190

200

1-Jan

15-Jan

29-Jan

12-Feb

26-Feb

12-Mar

26-Mar

9-Apr

23-Apr

7-May

21-May

4-Jun

18-Jun

2-Jul

16-Jul

30-Jul

13-Aug

27-Aug

10-Sep

24-Sep

8-Oct

22-Oct

5-Nov

19-Nov

3-Dec

17-Dec

31-Dec

Date

No

. of

bed

s o

ccu

pie

dSt John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, 91 good days in calendar year 2014

NHS LOTHIAN | ST JOHN'S HOSPITAL | CALENDAR YEAR 2014

120

130

140

150

160

170

180

190

200

1-Jan

15-Jan

29-Jan

12-Feb

26-Feb

12-Mar

26-Mar

9-Apr

23-Apr

7-May

21-May

4-Jun

18-Jun

2-Jul

16-Jul

30-Jul

13-Aug

27-Aug

10-Sep

24-Sep

8-Oct

22-Oct

5-Nov

19-Nov

3-Dec

17-Dec

31-Dec

Date

No

. of

bed

s o

ccu

pie

dSt John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, 91 bad days in calendar year 2014

NHS LOTHIAN | ST JOHN'S HOSPITAL | CALENDAR YEAR 2014

120

130

140

150

160

170

180

190

200

1-Jan

15-Jan

29-Jan

12-Feb

26-Feb

12-Mar

26-Mar

9-Apr

23-Apr

7-May

21-May

4-Jun

18-Jun

2-Jul

16-Jul

30-Jul

13-Aug

27-Aug

10-Sep

24-Sep

8-Oct

22-Oct

5-Nov

19-Nov

3-Dec

17-Dec

31-Dec

Date

No

. of

bed

s o

ccu

pie

dSt John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAY / Medical “downstream” occupied beds per day, good & bad days, calendar year 2014

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

6.0days

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

How full? can be derived as:

155 ÷ 26 = 5.96

(which I’ve rounded up to 6.0 days for the purposes of the grid)

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

6.0days

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

How full? If we operate on the basis that an average of 155 occupied beds in the downstream medical wards is the desirable figure, the “ought-to-be” number, then we can make some calculations about what we need to do i n order to achieve this number.

How many? Let’s assume for now that the number of ward stays (arrivals into the downstream wards) is something we can’t change – so it stays at 26 per day…

How full? can be derived as:

155 ÷ 26 = 5.96

(which I’ve rounded up to 6.0 days for the purposes of the grid)

Now let’s remind ourselves of what the actual calendar year 2014 figures were for the third – blue – column…

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

15patients

151minutes

26admissions

26admissions

148attendances

6.1days

29hours

157patients

33patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

A&E data comprises all arrivals during calendar year 2014 (n = 53,823). Average no. of attendances per day, average time in dept each day, average no. of people in dept at any one time (based on averages of 24 snapshots per day).

Assessment data comprises all inpatient ward stays in Wards 22 (PAA) and MAU during calendar year 2014 (n = 9,536). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time (recognising that the inpatient beds in Wards 22 are not used all the time).

Ward data comprises all inpatient ward stays (excluding those in Wards 22 and MAU) that were attributed to the specialties of CA, GA, GI, GM, HA, RESP or STROKEM during calendar year 2014 (n = 9,337). Average no. of ward stays per day, average length of ward stay, average no. of beds occupied at any one time.This to fit into a bed

complement of 36 + an element of Ward 22 (PAA)

This to fit into a bed complement of 142. Ward 9 (30) + Ward 21 (30) + Ward 25 (30) + Ward 8 (30) + Stroke Unit (22)

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

6.0days

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

This difference between 6.1 days and 6.0 days in the average length of stay for the downstream medical wards seems very small indeed.

But it’s worth bearing in mind that it’s just less than 2 hours 30 minutes, and that in order to achieve this reduction, we’d have to reduce everybody’s length of stay by 2.5 hours.

Or the equivalent. We’d need to reduce the number of occupied bed days per year by 950 in order to achieve this level of improvement (which would not only enable improved four-hour performance but would also – probably – enable a reduction in length of stay in Assessment that would make it less full and which – in turn – would allow the four-hour target in A&E to be met more frequently).

STEP 1: Better performance against the four-hour target

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

6.0days

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

This “ought-to-be” number of 155 includes patients who are occupying beds in the “wrong” wards.

Let’s take a closer look at the boarding that was happening in 2014 in the four main wards that seemed to be “lending” the most amount of beds to Medicine…

STEP 2: Can we reduce the amount of boarding?

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

Ward 12…

STEP 2: Can we reduce the amount of boarding?

NHS LOTHIAN | ST JOHN'S HOSPITAL | POST-ASSESSMENT MEDICAL INPATIENT ACTIVITY | 2014

SJH12

0

5

10

15

20

25

30

35

01/0

1/20

14

29/0

1/20

14

26/0

2/20

14

26/0

3/20

14

23/0

4/20

14

21/0

5/20

14

18/0

6/20

14

16/0

7/20

14

13/0

8/20

14

10/0

9/20

14

08/1

0/20

14

05/1

1/20

14

03/1

2/20

14

31/1

2/20

14

Date

No.

of b

eds

occu

pied

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

Ward 14…

STEP 2: Can we reduce the amount of boarding?

NHS LOTHIAN | ST JOHN'S HOSPITAL | POST-ASSESSMENT MEDICAL INPATIENT ACTIVITY | 2014

SJH14

0

5

10

15

20

25

30

35

01/0

1/20

14

29/0

1/20

14

26/0

2/20

14

26/0

3/20

14

23/0

4/20

14

21/0

5/20

14

18/0

6/20

14

16/0

7/20

14

13/0

8/20

14

10/0

9/20

14

08/1

0/20

14

05/1

1/20

14

03/1

2/20

14

31/1

2/20

14

Date

No

. o

f b

ed

s o

ccu

pie

d

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

Ward 15… (which looks more like a Winter Ward)

STEP 2: Can we reduce the amount of boarding?

NHS LOTHIAN | ST JOHN'S HOSPITAL | POST-ASSESSMENT MEDICAL INPATIENT ACTIVITY | 2014

SJH15

0

5

10

15

20

25

30

35

01/0

1/20

14

29/0

1/20

14

26/0

2/20

14

26/0

3/20

14

23/0

4/20

14

21/0

5/20

14

18/0

6/20

14

16/0

7/20

14

13/0

8/20

14

10/0

9/20

14

08/1

0/20

14

05/1

1/20

14

03/1

2/20

14

31/1

2/20

14

Date

No

. o

f b

ed

s o

ccu

pie

d

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

Ward 18…

STEP 2: Can we reduce the amount of boarding?

NHS LOTHIAN | ST JOHN'S HOSPITAL | POST-ASSESSMENT MEDICAL INPATIENT ACTIVITY | 2014

SJH18

0

5

10

15

20

25

30

35

01/0

1/20

14

29/0

1/20

14

26/0

2/20

14

26/0

3/20

14

23/0

4/20

14

21/0

5/20

14

18/0

6/20

14

16/0

7/20

14

13/0

8/20

14

10/0

9/20

14

08/1

0/20

14

05/1

1/20

14

03/1

2/20

14

31/1

2/20

14

Date

No

. o

f b

ed

s o

ccu

pie

d

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

6.0days

155patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

What boarding means is that – on average – about 15 beds per day of the 155 generated altogether by medical patients are occupied by boarders.

So if we wanted to achieve 98% four-hour performance and have a situation where there were no boarders, we’d need the 155 figure to reduce by 15 to 140.

(Except that 140 beds full on average out of a bed complement of 142 seems a bit on the high side – occupancy-wise: 98.6%. Whereas an occupancy of 137/142 (96.5%) (one empty bed in each of the five wards) seems more reasonable.)

Let’s see what would need to happen for the current ;levels of activity to fit into an envelope of 142 at 96.5% occupancy…

STEP 2: Can we reduce the amount of boarding?

Howfull?

Howlong?

How many?

HomecareWardsAssessmentA&E

26admissions

5.3days

137patients

St John’s Hospital / MEDICAL UNSCHEDULED CARE PATHWAYS

Calendar Year 2014 Notes

Using the same arithmetical logic that we applied before:

137 ÷ 26 = 5.27(Rounded to 5.3 in the grid)

This shows us what the average length of ward stay would need to be in the downstream medical wards if current levels of activity were to be accommodated without the need for boarding.

It assumes that an average percentage bed occupancy of 96.5% is consistent with good four-hour performance.

It’s important to bear in mind two things here.

One is that the number of ward stays will reduce if boarding is eliminated (because the 2014 figure of 26 per day includes boarding ward-to-ward moves.

The other is that it is likely that a reduction in boarding will of itself likely generate a reduction in length of stay (because we know that boarding is associated with longer length of stay)

STEP 2: Can we reduce the amount of boarding?