CHALLENGES FOR ACUTE SURGERY
Elective
Acute
Generic Models of Care
Improving Elective Practice
Improving Acute Practice
•
•
•
•
• Separate stream
• Early access to Senior
Decision Makers
• Acute Surgical Assessment
Units
2013
Pre-admission Assessment
Day Surgery
Day of Surgery admissions
Discharge planning
2010
Common goals
• Peri-operative Governance
• TPOT
• Designated beds and theatres
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2
Surgery Discharges between 2010 and 2014 (including Acute and Elective admissions for surgery or surgical care)
National figures
National surgical volumes comparing 2010 to 2014
Surgical volume ↑ X
12.0%
Bed day usage ↓ X
13.4%
Without improvments
267,632
Bed day savings
117,264 Extra BDUs at
a cost of €217,584,576
Marginal cost saving of
€22,162,802
Day Cases rate ↑ X
10.7%
Based on HIPE discharges in 2010 & 2014 for model 4, 3 & 2 Hospitals
excluding maternity & neonates discharges.
Marginal saving in direct costs is € 189 per BDU.
Fully loaded cost is € 813 per BDU.
Acute & Elective discharges from Model 4, 3 & 2 hospitals excluding Maternity, hospice and rehabilitation type hospitals
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3
NCP / HIU / HIPE / OpenApp -> NQAIS
3
WAITING LISTS
TROLLIES ↑
CANCEL PLANNED
ADMISSIONS
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4
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Hospital overload
EXCESS
UNPLANNED
CARE
DELAYED
DISCHARGES
•Poor, untimely planning
•Inadequate Fair Deal
•Inadequate Community
Care
•Increasing Numbers
•Increasing Age,
Chronic Diseases &
Complexity
•Inadequate or unused
1⁰ Care
•Inadequate access to
diagnostics
IN HOUSE
CONSTRAINTS
PLANNED CARE
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•Inadequate Resource
Beds
Diagnostics
Theatres
Workforce
•Inefficient Flow
Process
Performance
Integration
6
National HIPE discharges in 2014
AvLOS =
5.16 days
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GP referral to A*AU – under criteria guidance
AMAU/ASAU
Hospital
referral /
Transfer
Senior Decision
maker
GP
SELF
AEC
Senior Decision
maker
TRIAGE
SSU
AEC
Treat/ Follow
up/Discharge
Discharge path/GP
?
ED
CDU/RATU
Minor Injuries
RESUS
AMBULANCE
Inpatient
Ward
Inpatient
Out Patients
Senior
Decision
maker
(observer /
recover)
Theatre
ACUTE FLOOR - PATHWAYS TO ADMISSION AVOIDANCE OR EARLY DISCHARGE
ASAU advantages
1.
2.
3.
4.
5.
6.
7.
8.
9.
Rapid transfer from Triage or direct referral from Primary Care
Surgical cases are in one area. ‘Safari’ ward rounds avoided.
Quick prioritisation by experienced, focussed staff.
Maximises ambulatory emergency care; nurse-led early discharges .
Early imaging and diagnostics
Supports E D waiting time targets.
More rapid direct access to theatre
Shorter AvLOS & more positive patient experience..
Early Senior Decision Maker (Consultant) assessment.
Model 3 but ? Model 4
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Managing Inpatient Flow and Performance
Maximise
ambulatory care
Sept ’14
– Aug’ 15
Flow management
Complex support needs – hospital and
community based
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Managing Inpatient Flow and Performance
•
•
•
•
Whole system patient flow hubs/Demand and Capacity Management
Ward rounding discipline, Ward Cohorting, Discharge by 11
Pre-admission assessment, DOSA, Theatre management
Weekend working
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GENERAL
PRACTICE
MEDICINE
Model of
Care
SURGERY
EMERGENCY
MEDICINE
Model of
Care
Model of
Care
OLDER
PERSONS
COMMUNITY
CARE
Model of
Care
INTEGRATED CARE (COMMUNICATION and UNDERSTANDING) THAT SPANS
ORGANISATIONAL BOUNDARIES
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