Wrightington, Wigan and Leigh
NHS Foundation Trusts
Improving health outcomes across England by providing improvement and change expertise
Delivering NHS Services, Seven Days a Week
Dr Sanjay Arya
MBBS (Hons), FRCP (London), FRCP (Glasgow)
Consultant Interventional Cardiologist
Divisional Medical Director, Division of Medicine
Clinical Lead for Heart Failure, AQuA, North West
Improving health outcomes across England by providing improvement and change expertise
Delivering NHS Services,
Seven Days a Week
‘‘Patients who are admitted to hospital believe that they are
entering a place of safety, where they, their families and carers,
have a right to believe that they will receive the best possible care’’.
‘‘Yet there is evidence to the contrary. Patients who are unwell, or
become acutely unwell in hospital, may receive suboptimal care’’
Dr Mary Armitage, Guideline Development Group Chair
Acutely ill patients in hospital
Royal College of Physicians
Improving health outcomes across England by providing improvement and change expertise
Patients and family expect that the NHS will provide safe and high
quality service consistently seven days a week
There is a variation in care depending upon time of the day and
the day of the week
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Where there is a 7 day service, there is no observed difference in
mortality rates in the week and at weekend
(Bell M et all: The New England journal of Medicine 345:9) (Schmulewitz L et all: Clinical medicine Nov 2005)
Improving health outcomes across England by providing improvement and change expertise
Weekend mortality: Wigan 2001-11
474 excess deaths
2011 Fosters report: 5th from the bottom
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Weekend mortality: Wigan 2001-12
Improving health outcomes across England by providing improvement and change expertise
Weekend mortality: Wigan 2001-13
Improving health outcomes across England by providing improvement and change expertise
HSMR: March 12 – Feb 14
Improving health outcomes across England by providing improvement and change expertise
Our Patients
Outcome of Real Time Patient Surveys conducted monthly
Outcome of Real Time Patient Surveys conducted monthly
Apr-14
May-14
Have s taff treating and exam ining you introduced them s elves ?
90.8%
98.5%
Did you find s om eone to talk to about your worries and fears ?
83.2%
88.5%
Do you think the hos pital s taff did everything they could to help control your pain?
93.5%
93.9%
If your fam ily or s om eone els e clos e to you wanted to talk to a doctor, did they have enough opportunity to do s o?
87.0%
91.6%
Have you been involved as m uch as you wanted to be in decis ions about your care and treatm ent?
77.7%
85.5%
Have you been offered a choice of food during your s tay?
96.2%
97.7%
Has there been healthy food on the hos pital m enu?
91.8%
92.4%
Have you been involved in decis ions about your dis charge from hos pital?
57.1%
57.3%
Do you know which cons ultant is currently treating you?
72.8%
87.0%
Have you been given enough privacy when being exam ined, treated or dis cus s ing your care?
99.5%
98.5%
Have you always had acces s to a call bell when you needed it?
98.4%
93.9%
During your s tay have you been treated with com pas s ion by hos pital s taff
98.4%
98.5%
Have you been given the care you felt you required when you needed it m os t?
95.1%
98.5%
AVERAGE
87.8%
90.9%
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
The 10 Clinical Standards
Patient
Experience
Time to first
consultant
review
Shift
Handovers
MDT
Review
Quality
Improvement
Intervention
/Key services
Mental
Health
Transfer to
community
and Primary
and social care
On-going
review
Diagnostics
Improving health outcomes across England by providing improvement and change expertise
Addressing delivery of the national clinical standards
for 7 day services
‘A&E Clinical Quality Indicators’
Mr Ayaz Abbasi
MBBS , FRCS, FCPS, FCEM, PGC
Consultant, Emergency Medicine
Clinical Director, Emergency Medicine
Wrightington, Wigan & Leigh NHS Foundation Trust
Improving health outcomes across England by providing improvement and change expertise
Weekends
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Monday to Friday
Improving health outcomes across England by providing improvement and change expertise
A&E Clinical indicators
• 1
•
•
•
•
•
•
•
2
3
4
5
6
7
8
Ambulatory emergency care
Unplanned re-attendance rate
Total time in the A&E department
Left without being seen (LWBS) rate
Service experience
Time to initial assessment
Time to treatment
Consultant sign-off
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Unplanned Re-Attendance Rate
Unplanned Re-Attendance Rate
%UNPLANNED REATTENDANCE
TARGET
10%
9%
8%
7%
Rate
6%
5%
4%
3%
2%
1%
0%
Jun 13
Jul 13
Aug 13 Sep 13
Oct 13
Nov 13 Dec 13
Jan 14
Feb 14
Mar 14
Improving health outcomes across England by providing improvement and change expertise
Apr 14
May 14
Left without being seen
Left Without Being Seen Rate
%DID NOT WAIT
TARGET
10%
9%
8%
7%
Rate
6%
5%
4%
3%
2%
1%
0%
Jun 13
Jul 13
Aug 13
Sep 13
Oct 13
Nov 13
Dec 13
Jan 14
Feb 14
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Mar 14
Apr 14
May 14
Total time in ED
Site performance against national benchmarks and performance
Thr eshold
Non Admit t ed 95t h
06:00
05:00
Time (hh:mm)
04:00
03:00
02:00
01:00
00:00
May 13 Jun 13
Jul 13
Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Improving health outcomes across England by providing improvement and change expertise
A&E 4 Hours
Greater Manchester A&E Performance by Acute Trust
1st April 2013 to 31st March 2014
100%
99%
Please note activity for Central
Manchester is Level 1 activity only.
98%
97%
96%
95%
94%
93%
92%
91%
90%
Central
Manchester
Stockport
South
Pennine
Tameside
Manchester
Trust Stretch Threshold
Monitor Threshold
Wigan
Salford
National Mean
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Bolton
Time to Treatment
Site performance against national benchmarks and performance
Tar get
Median
01:30
Time (hh:mm)
01:15
01:00
00:45
00:30
00:15
00:00
May 13 Jun 13
Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
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Initial Assessment
Site performance against national benchmarks and performance
Tar get
95t h Per cent ile
00:30
Time (hh:mm)
00:25
00:20
00:15
00:10
00:05
00:00
May 13 Jun 13
Jul 13
Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14
Feb 14 Mar 14 Apr 14 May 14
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Ambulatory Care
Proportion of Attendances who are Admitted
%A&E Admissions wit h diag Cellulit is
%A&E Admissions wit h diag DVT
50%
40%
Rate
30%
20%
10%
0%
2013/14 Q1
2013/14 Q2
2013/14 Q3
2013/14 Q4
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2014/15 Q1
Consultant sign off
• Non traumatic chest pain in age seventeen and above.
• Any re attendance within 72 hours with a similar condition.
• Febrile child less then one year old.
All these conditions if discharged from ECC require consultant
sign off.
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SIGN-OFF DONE
CHEST PAIN
45%
(34/76)
55%
(42/76)
CHILDREN <1YR WITH
PYREXIA
(2/22)
(20/22)
REATTENDERS
36%
64%
OVERALL

9%
SIGN-OFF NOT DONE
(4/11)
37%
(58/109)
91%
(7/11)
63%
(69/109)
NB/ August Audit:
◦ Sign off done – 46%
◦ Sign off not done – 54%
Improving health outcomes across England by providing improvement and change expertise
Friends and Family Test
Accident & Emergency Friends & Family Test
Quality Scores for the Greater Manchester Area
Trust
Jan
Feb
Mar
April
May
Wrightington, Wigan & Leigh NHS FT
69
75
70
66
63
Central Manchester University NHS FT
62
50
64
61
60
Bolton NHS FT
59
49
44
47
56
University South Manchester NHS FFT
55
54
47
53
58
Salford Royal NHS FT
56
58
56
58
59
Pennine Acute Hospital NHS Trust
(Oldham Hospitals)
48
42
41
45
51
Stockport NHS FT
45
42
42
46
41
Tameside Hospital NHS FT
27
15
11
21
38
Improving health outcomes across England by providing improvement and change expertise
Thank you
Improving health outcomes across England by providing improvement and change expertise
Why are there more deaths?
‘Weekend Effect’
Is there a solution? Wigan experience
The whole health community needs to address the problem of
increased mortality over the weekend
•Engaged clinicians (medical,nursing,physio,OT) and managers
•Developed leadership: Divisional Director & 4 Clinical Directors
•Involved everyone: Martin Farrier’s weekly mortality data:
There should be a 7 day access to all aspects of care:
medical, nursing, diagnostics, GPs, Social services, Palliative care
• COE Consultants in the community – supporting GPs
• Engaged Nursing / Care homes – advanced care planning
• Improved end-of-life care for terminally ill patients – rapid discharge
Improving health outcomes across England by providing improvement and change expertise
Why are there more deaths?
‘Weekend Effect’
Is there a solution? Wigan experience
Right patient Right ward, beyond the first 24 hours of admission
•Specialists felt engaged, valued & comfortable in managing patients
•Increased daily senior review on medical wards
•Improved patient pathway / journey / care bundles
Increased Consultant presence: Cost effective / Reduces mortality
• Recruited more A&E and MAU consultants
• Increased presence of Consultants on A&E, MAU and Medical
wards on weekends and bank holidays
• 7 day 12 hour consultant delivered/presence service
Improving health outcomes across England by providing improvement and change expertise
Why are there more deaths?
‘Weekend Effect’
Is there a solution? Wigan experience
Support services will also need to adopt 7 day working practice if
the full benefits of 7 day Consultant service are to be realised
•Increased presence of Physio, OT and Social services over
weekends and bank holidays
•Increased availability of diagnostics over weekends and bank
holidays
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Addressing delivery of the
national clinical standards for 7
day services
Two questions to address –
1) What are the key challenges around the clinical
standards?
2) What suggestions do you have on how those challenges
can be overcome?
Please use post-it notes to capture your thoughts on key challenges in your
locality, you may add your contact details if you would like to discuss this
further with us at a later date
Improving health outcomes across England by providing improvement and change expertise
Refreshments
Improving health outcomes across England by providing improvement and change expertise