NDHB Hospital At A Glance

‘HaaG’

Mark GoodmanHospital Coordination Unit Nurse Manager

Hospital at a Glance Screen(HaaG)

A Variance Response Management tool to signal when patient and staff safety may be at risk due to a mismatch between

DemandClinical time needed to deliver care to patients, based upon acuity

&

CapacityClinical hours (staff & skills, resources available to deliver care)

Hospital at a Glance Screen will:

•Show a picture of the current status of the Hospital at a Glance.

•Initiate discussions and signal the need to employ “Variance Response Management Plans”

•Identify need & availability to guide the sharing of staff to support other areas who may be dealing with significant demand capacity mismatch.

Hospital at a Glance Screen

‘Bar Graph’ of (physical) capacity of each area.Shows physical beds and current utilisation.

Variance Indicator field below each areas barIncludes agreed area specific indicators that are designed to be

an alerting system

Can’t look at one without the other.

Care Capacity Variance•A selection of specific indicators that measure the pressure of resource demands and deficits of the ward/units.•Each area has a combination of common and unique indicators, including;

Staffing issues (skill mix, hours to care, etc).Patient acuityChurnProfessional judgement.

•A ‘real time’ holistic view

What happens with the information‘In the moment’

•Each time the ward Care Capacity Variance Indicator is saved it will:

•Update the Hospital at a Glance screen.

•Time stamp the change.

•Record what indicators were selected.

•Record what CCVB status was saved (colour).

Variance Response Management

.

Test Ward Variance Response Local After Hours Action PlanMauve

(Extra capacity)

Green

(Capacity matches demand )

Yellow

(Early variance)

Orange (Significant care capacity

deficit)

Red (Critical care capacity deficit).

Coordinator determines plan for the shift and communicates with Duty Manager

Expedite discharges:

Review patient management plans.Offer staff for period available (e.g. 1 hour, 2 hour, 4 hour, meal relief, full shift).

Staff maybe directed to area of greater variance

Review staffing for next 24hrs.

Pull patients in from other areas (e.g. outliers or ED)

If staff not required, consider offering annual leave or time in lieu (if owing).

Consider quality improvement activities

Coordinator determines plan for the shift and communicates with Duty Manager

Expedite discharges:Review EDD for patients’ expected to discharge in next 24hrs.

Review patient management plans.Escalate to medical team any patients not seen in last 24hrs.

Staff maybe directed to area of greater variance in consultation with Duty Manager.

Review staffing for next 24hrs.

Consider capacity to ‘pull’ patients in from other areas (e.g. outliers or ED)

Consider quality improvement activities

Ensure appropriate timely referrals to Allied Health

Coordinator determines plan for the staffing and shift and communicates with Duty Manager. Discuss assistance from other areas that have capacity

Receive assistance from other units as available – use SMART 5’s as appropriate

Coordinator remains on the unit.

Expedite discharges:

Review patient management plans.

Escalate to medical team any patients potentially for discharge

Repatriation of patients to other facilities/units.

Reassess status in 1 hour.

Review staffing for next 24hrs.

As per Yellow plus:

Notifies Duty Manager and requests specific resource eg additional staff or admit stop.

DNM considers use of staff from areas that are ‘green’

DNM/Coordinator consider calling in staff ,overtime, and/or extended shifts

Consider ‘admit stop’ till situation resolved

Ensure medical team are aware of status.

Reassess status in 1 hour

Put agreed care rationing measures in place

As per Orange plus:Mandatory reporting to Duty Manager and,Service Manager.

DNM/Coord take on floor co-ordination role as appropriate.

Implement “admit stop’

Put ‘life and limb’, agreed care rationing measures in place including rounding.

Reassess status in 30 minutes

If > 1hr notify GM on call

•Reporting available includes;

•Each Unit/Wards status over time.

•A record of what indicators were saved and who changed them.

What happens with the information‘longer term’

Variance Response Definitions

Mauve

(Extra capacity)

Green

(Capacity matches demand )

Yellow

(Early variance)

Orange (Significant care capacity

deficit)

Red (Critical care capacity

deficit).

We have the resource to assist other areas.

Not necessarily a whole shift.

All good.

Able to receive patients

Business as usual

We have stressors but are OK unless we request assistance.

Staff may miss breaks.

Please feel free to offer assistance – we may accept

New patients may need to be accompanied by resource

Usually will be managed locally.

Patient care may be compromised.

Staff prioritise care leading to care rationing

Staff may be working overtime and missing breaks.

Need additional resource/assistance to remedy.

UNACCEPTABLE

Needs fixing now.

?major incident

Ongoing work

•Reporting of HaaG data•Improving HaaG data•Reviewing indicators and plans•Local data councls

Challenges remaining

•Capturing the Hospital status•Representing Allied Health•Engaging medical colleagues•Embedding the system into culture