NDHB
Hospital At A Glance
‘HaaG’
Mark Goodman
Hospital 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
Demand
Clinical time needed to deliver care to patients, based upon acuity
&
Capacity
Clinical 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 bar
Includes 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 acuity
Churn
Professional 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 Plan
Mauve
Green
Yellow
(Extra capacity)
(Capacity matches demand )
(Early variance)
.
Coordinator determines plan
for the shift and
communicates with Duty
Manager
Coordinator determines plan
for the shift and
communicates with Duty
Manager
Expedite discharges:
Expedite discharges:
Review EDD for patients’
expected to discharge in next
24hrs.
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.
Review patient management
plans.
Escalate to medical team any
patients not seen in last
24hrs.
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.
Orange
(Significant care capacity
deficit)
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
Red
(Critical care capacity deficit).
As per Orange plus:
Mandatory reporting to Duty
Manager and,Service
Manager.
DNM/Coord take on floor coordination role as
appropriate.
Implement “admit stop’
Consider ‘admit stop’ till
situation resolved
Put ‘life and limb’, agreed
care rationing measures in
place including rounding.
Ensure medical team are
aware of status.
Reassess status in 30
minutes
Reassess status in 1 hour
If > 1hr notify GM on call
Expedite discharges:
Staff maybe directed to area
of greater variance in
consultation with Duty
Manager.
Review patient management
plans.
Escalate to medical team
any patients potentially for
discharge
Pull patients in from other
areas (e.g. outliers or ED)
Review staffing for next
24hrs.
If staff not required, consider
offering annual leave or time
in lieu (if owing).
Consider capacity to ‘pull’
patients in from other areas
(e.g. outliers or ED)
Repatriation of patients to
other facilities/units.
Consider quality
improvement activities
Consider quality improvement
activities
Reassess status in 1 hour.
Ensure appropriate timely
referrals to Allied Health
Review staffing for next
24hrs.
Put agreed care rationing
measures in place
What happens with the information
‘longer term’
•Reporting available includes;
•Each Unit/Wards status over time.
•A record of what indicators were saved and who changed them.
Variance Response Definitions
Mauve
(Extra capacity)
We have the
resource to assist
other areas.
Not necessarily a
whole shift.
Green
(Capacity matches
demand )
All good.
Yellow
Orange
Red
(Early variance)
(Significant care capacity
deficit)
(Critical care capacity
deficit).
Able to receive
patients
We have stressors
but are OK unless
we request
assistance.
Business as
usual
Staff may miss
breaks.
Please feel free to
offer assistance –
we may accept
New patients may
need to be
accompanied by
resource
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