ED Performance

ED Performance
Des FitzGerald
Consultant in Emergency Medicine, UHW
Clinical Lead for UnScheduled Care
ED Performance
In God we trust
All others bring data
UnScheduled Care
Paeds/Mat
OPD
Psych
ED/AMU
Day Wards
Day Cases
ingress
process
egress
Ingress
Process
Egress
ED Crowding
DATA
acquisition
Get our house
in order
iPMS
• ED processes /
streaming /
admission
avoidance
AMU / AMAU
Co-horting on
wards
Ward based
“firms” vs
teams
Patient Flow
Coordinator
Visual
Hospital
Delayed
Discharges
Sharing good
news /
achievements
DATA
acquisition
Get our house
in order
iPMS
• ED processes /
streaming /
admission
avoidance
Data Acquisition
Unrecognised
sources
Unaware of numbers
Incorrectly named
Incorrectly counted
The unpredicted
predictables
iPMS
New IT system UHW
November 2013
Teething Problems
Lack of clinician buy-in
Poor compliance
Excellent opportunity to instil
data and performance focus
Get our house in order
• Admitted patients are not “ours”
• We have no control over them
• Emergency Medicine patients are our patients
• Therefore do the best for OUR patients
25% of ED attendances are admitted.
Get our house in order
• Admitted patients are not “ours”
• We have no control over them
• Emergency Medicine patients are our patients
• Therefore do the best for OUR patients
75% OF ATTENDANCES ARE DISCHARGED!!
6hr YTD
9hr YTD
ADMITTTED
6hr PET
9hr PET
DISCHARGED
6hr PET
9hr PET
A
59%
74%
50.4%
73.9%
65.7%
81.0%
B
72%
87%
70.1%
81.6%
68.6%
87.1%
C
62%
77%
-
-
-
-
D
76%
86%
62.9%
72.5%
71.6%
79.9%
UHW
79%
87%
44.3%
57.4%
88.9%
95.6%
National
Rank (UHW)
#3
#7
#1
#4
PET 2013
PET 2014
How others see you…
Why the deterioration in Performance
in Nov & Dec?
% of pt with a Total ED Time < 6 hours
(Target :95%)
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
% of pt with a Total ED Time >9 hours
(Target :0)
30.0%
25.0%
80.4%
81.44%
81.55%
79.10%
20.0%
78.42%
15.0%
10.0%
9.4%
12.72%
14.42%
5.0%
0.0%
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
average time 'lodged' in ED (mins)
(i.e.awaiting bed allocation)
% of pt with a Total ED Time >24 hours
5.0%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
10.45%
11.28%
700
648
600
3.65%
500
493
400
397
300
1.82%
200
1.22%
100
0.8%
0.5%
Aug-14
280
222
0
Sep-14
Oct-14
Nov-14
Dec-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Delayed Discharge Counts
Weekly snapshots: Nov & Dec 2013 and 2014
35
29
30
29
26
24
25
22
20
24
20
15
19
16
22
17
21
16
24
25
23
19
22
19
17
10
5
0
Nov Wk 1 Nov Wk 2 Nov Wk 3 Nov Wk4 Dec Wk1 Dec Wk 2. Dec Wk 3. Dec Wk 4. Dec Wk 5. Jan Wk 1.
Delayed
discharges 2014
Delayed
discharges 2013
AvLOS for Med Pts discharged with LOS>30days
80
days
75
70
65
60
55
50
66.38
45
55.42
40
35
30
July-Dec 2013
July-Dec 2014
Stay Focussed!
UHW Highest performing ED in the country for
NON-ADMITTED PATIENTS
Week 4 2015
94.9% for 6 hr
97.5% for 9 hr
But not focussed on “targets”