– COVER SHEET Meeting Date: 30 May 2012

INTEGRATED PERFORMANCE REPORT – COVER SHEET
Meeting Date: 30 May 2012
Agenda Item: 1.10
Paper No: E
Title:
Integrated Performance Report
Purpose:
To report on performance against key indicators for the Trust in April
2012.
Summary:
Financial Performance
The Trust has achieved a surplus of £28k for the month of April 2012
against a planned deficit of £38k. The reported surplus includes nonrecurring income / costs in line with plan, which contribute a total of
£40k. The ‘normalised’ deficit for the month before non-recurring
elements is therefore -£(12)k
Cash at the end of April is £17.6m against plan of £15.7m. Cash at
the end of April was higher than the true underlying position because
of high level of capital creditors and high level of trade creditors.
The Trusts Financial Risk Rating (‘FRR’) for the month is 3. The
Trust’s level of financial performance is only marginally above that
which would reduce FRR to 2 (Headroom of only £25k).
Clinical Performance & Quality
All Cancer standards were achieved for March and Qtr 4.
All three RTT targets achieved in April.
A&E performance against the 95% target was achieved in April.
Recommendation: For discussion and noting.
Prepared PAUL TURNER
by:
Director of Finance
/ KATE THOMAS
Performance Manager
Presented
by:
This report is relevant to: (Please tick relevant box)

Assurance Framework
PAUL TURNER Director of Finance
MARY SHERRY Chief Operation Officer
MARTIN SMITS Director of Nursing
SARAH-JANE TAYLOR HR Director
Risk Register I/D No.
Healthcare Standards:
Please specify which standard
Monitor compliance

Financial implications
YES

Human Resources implications
YES
Internal monitoring

Legal implications
NO
INTEGRATED PERFORMANCE REPORT
TRUST PERFORMANCE SUMMARY
April 2012
Target /
Limit
Year End
23.0
18.0
2012-13
2011-12
Feb-12 Mar-12 Apr-12
Direction #
2010-11
Year To Date
Year End
YTD/
current
Actual
YTD
Target /
Limit
18.9
-
17.4
-
94.5%
90%
1.0
96.1%
95%
1.0
92.7%
92%
1.0
90.1%
85%
100.0%
90%
100.0%
98%
100.0%
94%
99.3%
94%
100.0%
96%
95.8%
93%
100.0%
93%
95.8%
95%
Forecast
Monitor
targets &
weightings
ACCESS AND TARGETS
Referral to waiting time (weeks) for admitted (95th centile)
Referral to waiting time (weeks) for non-admitted (95th centile)
RTT
Referral to treatment (18 weeks) for admitted
Referral to treatment (18 weeks) for non-admitted
18.3
90%
95%
14.7
97.6%
98.7%
24.3
17.0
88.7%
97.0%
21.3
17.0
92.5%
96.6%
Referral to waiting time (18 weeks) for incomplete pathways
92%
0.0
94.8%
93.5%
Maximum 62 day wait from referral to treatment for all cancers
85%
91.6%
92.1%
90.1%
62 day wait for 1st treatment - consultant screening service (all)
90%
100.0%
100.0% 100.0%
cancer
31 day wait for 2nd or sub treatment : Anti cancer drug treat
98%
100.0%
100.0% 100.0%
31 day wait for 2nd or sub treatment : Surgery
94%
90.3%
100.0% 100.0%
31 day wait for 2nd or sub treatment : Radiotherapy
94%
31 days wait diagnosis to start of 1st treatment: All cancers
96%
99.2%
100.0% 100.0%
2 week wait from urgent GP referral to 1st appt (susp cancer)
93%
97.3%
98.1%
95.8%
2 week wait for Symptomatic Breast Patients
93%
94.8%
93.3%
100.0%
percentage of patients within the 4 hour target
95%
98.6%
97.2%
96.1%
99.3%
18.9
17.4
94.5%
96.1%
92.7%
99.3%
95.8%
A&E
Total time in A+E (95th centile) from Q1
=< 4 hours
Time to initial asessement (95th centile) from Q2
=< 15 mins
Time to treatment decision (median) from Q2
=< 60 mins
56
67
51
=< 5%
3.33%
2.83%
2.97%
=< 5%
3.09%
3.35%
3.03%
Unplanned reattendance rate from Q2
Left without being seen from Q2
cardiac
Heart attack patients to receive thrombolysis within 60 mins of call
3hrs 59 3hrs 59 3hrs 59
12
12
15
access
breast screen
68%
75%
2 week maximum wait for Rapid Access Chest Pain Clinic appt
0
0
0
0
0
No waits more than 6 weeks for diagnostic investigations
0
78
29
27
17
Elective Access - rebooking
0
0
0
1
0
Patients who spend at least 90% of their time on a stroke unit
80%
70%
68%
68%
82.1%
Higher risk TIA cases who are treated within 24 hours
60%
80%
Outpatient Access : ASIs at =< 4%
4%
11%
8%
8%
7%
Screening to normal results within 14 days
90%
96.4%
97.3%
96.8%
96.1%
Screening to assessment in 21 days - screening to 1st appt offer
90%
96.9%
100.0%
94.8%
96.0%
Screening to assessment in 21 days - screening to attended appt
90% of eligible woman screened within 36 months
90%
88.2%
98.6%
92.2%
94.4%
90%
99.5%
99.2%
99.2%
97.2%
↑
↓
↑
↓
↓
↓
↔
↔
↔
↔
↔
↓
↑
↓
↔
↓
↑
↓
↑
↔
↔
↑
↑
↓
↑
↑
↓
↑
↑
↓
3hrs 59
=< 4 hours
15
=< 15 mins
51
=< 60 mins
2.97%
=< 5%
3.03%
=< 5%
100%
68%
0
0
17
0
0
0
82.1%
80%
80%
60%
7%
4%
96.1%
90%
96.0%
90%
94.4%
90%
97.2%
90%
1.0
1.0
0.5
0.5
1.0
15.7
2011-12
Target /
Limit
Year End
Delayed transfers of care to be maintained at a minimal level
3.5%
5.4%
3.2%
6.2%
2.3%
Trauma inpatients (fit for surgery) receive treatment within 48 hrs
Hip fractures (fit for surgery) receive treatment within 48 hrs
95%
93%
98%
96%
94%
95%
89%
94%
96%
97%
100
81.9
75.6
All deaths - actual as % of expected (Dr Foster)
100%
105%
76%
HSMR deaths - actual as % of expected (Dr Foster)
100%
100%
76%
all
9
0
1
1
0
11
0
1
1
Theatre Utilisation - Main
85%
88%
85%
87%
86%
Theatre Utilisation - Day
85%
73%
75%
74%
77%
Day Case Rates (basket of 25)
Bed Occupancy
75%
86%
82%
95%
96%
100%
96%
meeting the C-Diff objective (ytd)
=<24
42
22
24
2
meeting the MRSA objective (ytd)
=<1
4
1
1
0
Feb-12 Mar-12 Apr-12
Direction #
2010-11
↑
↓
↑
Year To Date
Year End
YTD/
current
Actual
YTD
Target /
Limit
2.3%
3.5%
94%
95%
97%
95%
75.6
10000%
76%
100%
76%
100%
1
all
1
0
86%
85%
77%
85%
82%
75%
96%
95%
2
=<24
1.0
0
=<1
1.0
Forecast
Monitor
targets &
weightings
CLINICAL QUALITY
Dr Foster Mortality relative risk rating (3 month rolling)
Number of SUIs reported within appropriate timeframe
Number of Serious Untoward Incidents (SUIs)
↑
↑
↑
↔
↔
OPERATIONAL EFFICIENCY
96%
↓
↑
↑
↔
PATIENT EXPERIENCE
↔
↔
STAFF EXPERIENCE
Staff Turnover (Overall)
Staff Turnover (Auxiliaries and HCAs)
Absence
<=11%
0.64%
0.28%
0.92%
0.50%
<= 13.5%
0.84%
0.44%
1.54%
0.87%
<=3.5%
3.58%
3.59%
3.58%
3.58%
9.0
15.2
15.4
17.6
↑
↑
↔
0.50%
<=11%
0.87%
<= 13.5%
3.58%
<=3.5%
FINANCE & ACTIVITY
Cash balance
17.6
15.7
13.4
193.9
179.9
Income
188.80
16.21
21.20
15.97
15.97
15.97
Operating Expenditure
181.70
14.76
20.30
14.94
14.94
15.0
7.30
1.45
0.70
1.03
0.82
0.82
1.03
0.75
11.2
5.9%
EBITDA
EBITDA %
3.9%
8.9%
3.3%
6.5%
5.2%
5.2%
6.5%
4.8%
Surplus/Deficit
-4.30
0.40
-0.30
0.04
0.03
0.04
0.03
-(0.04)
2.1
SLA over / (under) performance
n/a
-
0.1
0.15
0.0
0.0
0.15
0.0
0.0
0.0
CIP
6.6
1.1
0.8
0.44
0.4
0.4
0.44
0.46
8.3
2
3
3
3
3
3
3
3
Financial Risk rating
# : Arrow direction indicates improvement ↑, deterioration ↓, or no change ↔ in performance since the previous month
INTEGRATED FINANCE AND PERFORMANCE REPORT
Month One - April 2012
Key Issue
Trust
Performance
– Monitor
Targets
Executive Summary
KPI
All cancer targets were met in March and Q4, the most recent data available.
The monthly cancer report and charts are appended
Cancer
A&E has achieved the 95% target for April.
ED
Note: The Trust rating for Quarter 4 2011/12 has been altered by Monitor to amber/green due to February
failure of RTT18 (admitted patients).
RTT
MRSA
Monitor scorecard
Action : Exception report is appended
Both MRSA and C-Diff performance have sustained improvement in the previous year and therefore
achieving their target.
Sch
G
The 2011-12 monitor scorecard is comprised of 14 key indicators. All have been achieved in April, or
March /Q4 where this is the most up to date data available.
Admitted RTT (94.5%), non Admitted RTT (96.1%) and RTT incomplete pathways (92.7%) were achieved
for April at aggregate level.
The clearance of the general surgery and gynaecology backlog within the aggregate target will be
undertaken during Q1, without compromising trust aggregate performance.
RTT Exception Report appended.
RAG
Key Issue
Trust
Performance
– Finance &
Activity
Executive Summary
KPI
The Trust has achieved a surplus of £28k for the month of April 2012 against a planned deficit of £38k.
The reported surplus includes the following non-recurring income / costs (both in line with plan)
•
•
donated income
merger costs
The Trusts Financial Risk Rating (‘FRR’) for the month is 3.
only marginally above that which would reduce FRR to 2.
The Trust’s level of financial performance is
The Trust has not yet identified all the necessary savings required to deliver the targeted surplus for the
year. There is therefore a significant risk that the targeted surplus of £2.1m will not be achieved. (Separate
report to Finance and Investment Committee in May)
Sch
G
Trust I&E table
Cash at the end of April is £17.6m against plan of £15.7m. Cash at the end of April was higher than the true
underlying position because of high level of capital creditors (Varian upgrades) and high level of trade
creditors.
All
financial
variances
with
specific
focus on:
•Income
•EBITDA
•CIP
•Cash
•Capital
spend
RAG
Key Issue
Trust
Performance
– Access and
Targets
Executive Summary
KPI
RAG
Sch
The Access and Targets scorecard is comprised of 22 key indicators, of which only 3 are red rated.
•
•
RTT
Admitted RTT (94.5%), non Admitted RTT (96.1%) and RTT incomplete pathways (92.7%) were
achieved for April at aggregate level.
The clearance of the general surgery and gynaecology backlog within the aggregate target will be
undertaken during Q1, without compromising trust aggregate performance.
RTT Exception Report appended.
Diagnostic Access
There were 17 Endoscopy patients waiting in excess of the 6 week diagnostic target at the end of April,
an improvement on the previous month, and the lowest level since March 2010.
Action : The Department Has now met with the PCT to discuss the findings of the IST review and will
continue to work wit the PCT to reduce referrals where possible.
Exception Report is appended
Delayed Transfers of Care
The delayed discharge percentage for April is 2.3%, bed occupancy (month average) continued to
exceed 95% in April .
Action : There continues to be a number of targeted actions in progress to reduce delays further.
Exception and Update Reports appended
•
Outpatient Access
The ASIs percentage has reduced to 7%, exceeding the 4% PCT target.
Action: The Trust continues to flex polling ranges in line with national guidance, and has reviewed the
underlying ASI reasons. System changes are also planned to improve the Trusts ability to protect new
slots.
•
48 hours standard for #NoF and Trauma
The 48 hour operating target (95%) was achieved for fractured neck of femur patients (97%) but not
general trauma (94%) in April. Exception Report is appended
•
Emergency Department : 4 hour target (95%) :
The 4 hour wait target of 95% was met in April.
Exception Report is appended
•
Stroke
The 80% target was achieved in April (82.1%). Exception Report is appended
Cancer
A-G
RTT
Diagnostic
Access
Delayed
Transfers
of Care
Outpatient
Access
48 hours
standard
for #NoF &
Trauma
ED 4 hr
target 95%
Stroke
Access and Targets Scorecard
•
Cancer
All cancer targets were met in March and Qtr 4.
The monthly cancer report and charts are appended for March
Trust
Performance
– Patient
Experience
•
•
Theatre Utilisation
Main Theatre 86%
Day theatre 77%
Theatre
Utilisation
•
Bed Occupancy
Average bed occupancy has exceeded 95% in April (96%).
Bed
occupancy
The Patient Experience scorecard is comprised of 6 key indicators, 3 of these are part of the Monitor
scorecard. For the most recent year to date position (March 2011) there are no red rated indicators:
•
•
•
Sch
G
A-G
G
Mortality
SUI
The Efficiency scorecard is comprised of 4 key indicators; none of these are part of the Monitor scorecard.
For the most recent year to date position ( February/April 2012) there are two red rated indicators:
C-Diff
There have been 2 cases of C-Diff during the period 1 to 30 April 2012 . The annual objective set by
Monitor is to maintain/ improve upon the previous year’s performance (24), which is being achieved.
RAG
Patient Experience Scorecard
The Clinical Quality scorecard is comprised of 5 key indicators, none of which are part of the Monitor
scorecard. For the most recent year to date position (February/April 2012) there is one red rated indicator
relating to a single SUI in April , this was reported within the appropriate timescale.
Mortality continues to perform better than expected (as defined by Dr Foster)
Trust
Performance
– Efficiency
KPI
Efficiency Scorecard
Trust
Performance
– Clinical
Quality
Executive Summary
Clinical Quality
Scorecard
Key Issue
C Diff
objective
MRSA
There have been no further cases of MRSA since May 2011.
Action :Infection Control issues under continued scrutiny by Performance and Director of
Nursing/Infection Control.
MRSA
objective
MSA
There have been no breaches of mixed sex accommodation (MSA) in April.
Mandatory reporting of MSA via Unify commenced in April.
Mixed Sex
Accomodation
Trust I&E
Month - April
Year to Date
Full Year
Actual
Plan
Variance
Last Year
Actual
Plan
Variance
Last Year
Forecast
Plan
Last Year
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
9,570
3,798
353
367
1,679
15,767
200
15,967
9,570
3,798
353
367
1,686
15,774
200
15,974
0
0
0
0
(7)
(7)
0
(7)
9,457
3,798
315
375
1,608
15,553
0
15,553
9,570
3,798
353
367
1,679
15,767
200
15,967
9,570
3,798
353
367
1,686
15,774
200
15,974
0
0
0
0
(7)
(7)
0
(7)
9,457
3,798
315
375
1,608
15,553
0
15,553
114,834
45,572
4,234
4,400
22,038
191,078
2,813
193,891
114,834
45,572
4,234
4,400
22,038
191,078
2,813
193,891
118,639
45,914
4,855
4,203
21,140
194,751
301
195,052
Pay Costs
Non-Pay Costs
(10,591)
(4,355)
(10,593)
(4,426)
2
71
(10,394)
(4,282)
(10,591)
(4,355)
(10,593)
(4,426)
2
71
(10,394)
(4,282)
(127,711)
(52,172)
(127,711)
(52,172)
(127,940)
(54,247)
Total Operating Expenditure
(14,946)
(15,019)
73
(14,676)
(14,946)
(15,019)
73
(14,676)
(179,883)
(179,883)
(182,187)
0
0
0
0
0
0
0
0
0
0
(218)
821
(747)
4
(250)
755
(749)
6
(250)
66
2
(2)
0
877
(730)
8
(258)
821
(747)
4
(250)
755
(749)
6
(250)
66
2
(2)
0
877
(730)
8
(258)
11,195
(8,986)
78
(3,000)
11,195
(8,986)
78
(3,000)
12,346
(8,859)
95
(2,928)
28
0
28
40
(12)
(38)
0
(38)
40
(78)
66
0
66
0
66
(103)
0
(103)
83
(186)
28
0
28
40
(12)
(38)
0
(38)
40
(78)
66
0
66
0
66
(103)
0
0
83
(186)
2,100
0
2,100
400
1,700
2,100
0
2,100
400
1,700
955
(839)
116
(2,175)
3,130
Contract Income - B&P PCT
Contract Income - Dorset PCT
Contract Income - Specialist Commissioning
Contract Income - Other
Other Operating Income
Total Operating Income
Charitable Income
Total Income
Profit/(Loss) on disposal of fixed assets
EBITDA
Depreciation
Interest Receivable/(Payable)
Dividend
Surplus/(Deficit)
Impairment
Surplus/(Deficit) after Impariment
Non-recurring income / (costs) incl. above
Normalised Surplus/(Deficit)
Key Observations
The Trust has achieved a surplus of £28k for the month of April 2012 against a planned deficit of £38k.
The reported surplus includes the following non-recurring income / costs (both in line with plan)
•
•
£200k donated income. The income relating to confirmed donated assets (MRI, oncology
management system etc) totals £2.4m and is being released in equal 12ths. A further £0.4m
relating to cardiac development not yet confirmed is included in financial plan in March 2013
£100k relating to merger costs. Plan assumes £1.2m for year which has been phased in equal
12ths. £100k per month will be charged per month unless it becomes clear that the total for the
year is significantly over/under-stated.
Forecast
Key Actions
PERFORMANCE EXCEPTION REPORT
Emergency Department Professional Standards
The Risk:
At month end in April all six key performance indicators were met (an improvement from March
when the clinician seen time was not met). The clinician seen time median performance was 51
minutes in April (target = 60 minutes), an improvement of 16 minutes from the March performance.
Current Position and Actions:
The Emergency Department delivered the 4 hour target for April (95.84%). This was a decline from
the March overall position of 96.11%, however the month of April included the Easter break and
consequently some high attendance patterns. Some of this was predicted and planned for, however
there were a number of days where presentations were over 200 in a 24 hour period, which had not
been predicted.
The action plan remains in place. It is clear that there remain day to day issues which need to be
tackled and there are a number of “avoidable” breaches, which if all processes were robustly
implemented every hour of the day and night could improve the position. However, it is also clear
from the review work undertaken that the department is understaffed to deliver a higher performance
and this can be particularly pertinent at certain times of the day (6pm to midnight in particular). The
Business case for staffing remains unresolved, as funding has yet to be identified.
Staffing continues to be the biggest risk to performance, and there are additional challenges
expected from August due to a reduction in SpR numbers. Actions to seek overseas staff, and
alternative skill-mix staffing solutions are being developed.
The indicators are monitored daily by the team and action taken to improve where standards appear
to be dropping.
Poole Hospital NHS Foundation Trust
Weekly Progress Chart - A&E 4 hour 95% target
Weekly and Quarterly Position
100.00%
98.00%
96.00%
94.00%
92.00%
90.00%
88.00%
86.00%
84.00%
82.00%
13-May-12
98% target
06-May-12
Sarah Knight
Directorate Manager – Emergency Services
14 May 2012
95% target
29-Apr-12
qtr to date % seen within 4 hours
22-Apr-12
weekly % within 4 hours
15-Apr-12
08-Apr-12
25-Mar-12
01-Apr-12
18-Mar-12
11-Mar-12
04-Mar-12
26-Feb-12
19-Feb-12
12-Feb-12
05-Feb-12
29-Jan-12
22-Jan-12
15-Jan-12
08-Jan-12
01-Jan-12
25-Dec-11
18-Dec-11
11-Dec-11
27-Nov-11
04-Dec-11
20-Nov-11
13-Nov-11
06-Nov-11
30-Oct-11
23-Oct-11
16-Oct-11
09-Oct-11
02-Oct-11
week ended
PERFORMANCE EXCEPTION REPORT
Referral to Treatment (RTT) - Admitted: Trust performance for April is 94.5%
Summary:
Although the Trust achieved the 90% RTT target, General Surgery breached at 88.9% along with
Gynaecology at 87.2%. ENT achieved the target in April with 96.6% and is out of ‘recovery’.
Current Position:
At 14th May 2012, the predicted performance for May is 87.8% in General Surgery, and 80.6% in
Gynaecology. It has been agreed with the PCT that the 90% target for these specialities does not
have to be achieved in May.
Actions for May 2012:
1. Overall Strategy and Target
•
•
•
It has been agreed with the PCT that General Surgery must achieve and sustain 90% from
June onwards, and Gynaecology from July onwards.
Accepting that an agreement has been made with the PCT that the 90% target for these
specialities does not have to be achieved in May, the Surgical Admissions Office is focusing
upon booking as many breaches as possible, without compromising the Trust’s overall
performance.
Having worked closely with the Consultant Gynaecologists to identify suitable patients, the
Division is working closely with the PCT to transfer day case patients and inpatients to the
private sector; once treated, it has been agreed these will be recorded by the Trust as nonadmitted breaches.
2. Increasing capacity within General Surgery and Gynaecology
•
•
•
•
•
Additional weekday lists in General Surgery and Gynaecology continue
Within General Surgery, the waiting list is being analysed by two Consultant Surgeons to
identify which patients can be operated on by a Clinical Fellow, freeing up their time to
operate on the more clinically complex patients.
Within General Surgery work is identifying if the case mix of an Associate Specialist can be
increased, if the theatre schedule can be altered, to ensure they are operating whilst a
Consultant Upper GI Surgeon is present in theatres.
Within Gynaecology, processes are being put in place to ensure that when a decision to
admit is made, the admitting Consultant can identify which Consultant colleagues could
undertake the procedure, allowing for more booking flexibility.
Theatre schedule continues to be reviewed to increase capacity for additional activity in May
onwards.
3. Booking strategy
•
•
The Performance Manager has provided the Division and the Surgical Admissions Office
with data as to how many breach patients can be booked in the month whilst achieving the
Trust 90% aggregate level target.
The Senior Admissions Officer is working closely within the Business Manager (Surgery)
regarding breach patients who remain on the waiting list without a date for their operation.
4. Performance and Monitoring Strategy
•
•
•
•
•
The performance team, admissions and management continue to validate, on a week by
week basis, all patients admitted in the last 7 days who have breached 18 weeks.
Weekly progress meetings to be held with the Chief Operating Officer.
An intensive review of current processes and practices was undertaken w/c 9th April 2012,
by an external operational manager who will meet with key Divisional staff;
recommendations for change are being implemented.
A review of the reports required to manage RTT from an operational perspective continues.
Following attendance at an NHS South of England workshop on RTT, recommendations for
delivery of RTT will be reviewed and adopted where appropriate
COO Additional Note
The Board will be kept informed on a monthly basis on progress. The up to date position will be
shared with the Board at the May Board Meeting.
Suzie Scaddan
Business Manager – Surgical Services
14 May 2012
Cancer Waiting Times MARCH 2012: Poole Hospital NHS Foundation
Trust – Summary report
The following convention is used for indicating compliance with the performance standards.
Standard achieved or
exceeded
Performance within
10% of standard
Performance more than
10% below standard
Data are taken from the Open Exeter national database for Cancer Waiting Times.
Scorecard
The arrows in the scorecard indicate whether performance has increased decreased or stayed the same
relative to the previous month.
14 days: Urgent GP referral to Date First Seen
Maximum 2 week wait from urgent GP referral for suspected cancer to first hospital assessment by 2000
Measure
Everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they
need to be seen urgently and requesting an appointment by 2000
Target
93% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
Tumour Type
Total
% meeting
referrals standard
seen
in Poole
during the
period
Suspected brain/central nervous system tumours
Suspected breast cancer
Suspected children's cancer
Suspected gynaecological cancer
Suspected haematological malignancies (excluding acute leukaemia)
Median
wait
National
%
meeting
standard
6
98
100
100
11
5
97.4
97.7
4
100
9
97.7
27
96.3
8
96.4
1
100
2
97.3
Suspected head & neck cancer
62
91.9
10
96.9
Suspected lower gastrointestinal cancer
78
89.7
12
94.7
Suspected lung cancer
16
100
10
98.1
Suspected other cancer
1
100
2
99.3
1
100
4
97.1
80
31
405
98.8
93.5
95.8
7
11
96.9
94.6
96.2
Suspected sarcoma
Suspected skin cancer
Suspected upper gastrointestinal cancer
Totals
Breach reasons
No. of
patients
Breach reasons
st
16
Patient cancelled/declined 1 . OPA/investigation within target
1
Lack of availability of clinic slots
14 days: All breast symptom referrals
Measure
Maximum 2 week wait from referral of any patient with breast symptoms to first hospital assessment by
DECEMBER 2010
Target
93% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
Totals
Total referrals
seen during the
period
% meeting
standard at
Poole
42
100
Median National
wait
% meeting
standard
7
96.2
Breach reasons
No breaches
31 days: Decision to Treat to First Treatment
Measure
Maximum 31 day wait from decision to treat to first treatment for all cancers by 2005
Target
96% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
a) By tumour site
Tumour Type
Patients
treated
following an
urgent
referral for
suspected
cancer
Total
treated
0
3
3
0
100
11
100
Breast
11
23
23
0
100
11
99.6
Gynaecological
10
20
20
0
100
8
98
Haematological
4
12
12
0
100
9
99.9
Head & Neck
8
11
11
0
100
12
97.8
Lower Gastrointestinal
5
17
17
0
100
9
98.7
Lung
4
24
24
0
100
8
99.4
Sarcoma
0
1
1
0
100
2
97.2
10
22
22
0
100
4
98.5
2
14
14
0
100
1
99.4
3
57
6
153
6
153
0
0
100
100
0
97.1
98.7
Brain/Central Nervous System
Skin
Upper Gastrointestinal
Urological
All Cancers
Treated on Treated Poole % Median
or within after 31 meeting Waiting
31 days
days
standard
Time
National
%
meeting
standard
b) By treatment type
Treatment Group
Patients
Patients
Patients Patients
Total
treated
treated
treated
treated treated
following an following following following
urgent
an urgent an urgent a referral
referral for
referral
referral
from
suspected
for breast from an
another
cancer
symptoms
NHS
source or
Cancer
urgency
Screening
Service
Treated Treated Poole % Median National
on or
after 31 meeting Waiting
%
within 31
days
standard
Time
meeting
days
standard
Drug Treatments
16
0
1
15
32
32
0
100
4
99.9
Palliative Treatments
5
0
0
17
22
22
0
100
0
100
Radiotherapy Treatments
10
0
0
21
31
31
0
100
9
98.8
Surgery
26
0
12
30
68
68
0
100
14
97.8
All Treatments
57
0
13
83
153
153
0
100
Breach reasons
No breaches
31 days: Second and Subsequent Treatments
Measure
Maximum 1 month wait from ready to treat to treatment for all second and subsequent treatments
(chemotherapy and surgery by December 2008, all other treatments DECEMBER 2010)
Target
98% - Anti Cancer drug treatments ; 94% - Surgery treatments ; 94% - Radiotherapy treatments
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
98.7
a) By tumour site
Tumour Type
Total
treated
Treated
on or
within 31
days
2
2
0
100
7
99.1
Breast
101
101
0
100
7
98.7
Gynaecological
21
21
0
100
2
99.4
Haematological
18
18
0
100
2
99.1
Head & Neck
15
14
1
93.3
27
97.6
Lower Gastrointestinal
19
19
0
100
1
98.8
Lung
26
26
0
100
7
99.4
Other
1
1
0
100
0
99.6
Sarcoma
4
4
0
100
5
99.7
Skin
20
20
0
100
15
98.4
Upper Gastrointestinal
Urological
All Cancers
13
64
304
13
64
303
0
0
1
100
100
99.7
3
0
98.7
97.6
98.6
Treated Poole % Median
after 31 meeting Waiting
days
standard
Time
National
%
meeting
standard
Brain/Central Nervous System
Treated Poole % Median
after 31 meeting Waiting
days
standard
Time
National
%
meeting
standard
b) By treatment type
Treatment Group
Drug Treatments
Other Treatments
Palliative Treatments
Radiotherapy Treatments
Surgery
All Treatments
Total
treated
Treated
on or
within 31
days
87
3
32
149
33
304
87
3
32
148
33
303
0
0
0
1
0
1
100
100
100
99.3
100
99.7
1
27
0
8
20
99.7
97.1
99.9
98.2
97.4
98.6
Breach reasons
Tumour
Type
Wait
Report
Days
Head & Neck 39
Patient needed several extractions prior to starting RT - was admitted 22/2/12 but session overran and patient
refused to wait so had to be re-booked. Delay in dental extractions caused 1-2 week delay in radiotherapy.
62 days: Urgent GP referral to First Treatment
Measure
Maximum 62 day wait from urgent GP referral to first treatment for all cancers by 2005
Target
85% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
a) By tumour site
Actual no.
treated
Accountable Accountable Poole % National
total over meeting
total treated
%
target
standard meeting
standard
11
0
100
98.1
Breast
11
Gynaecological
10
6.5
0
100
89.1
Haematological
4
3.5
1
71.4
86.4
Head & Neck
8
6.5
1
84.6
81.2
Lower GI
5
5
1
80
82.1
Lung
6
4
0.5
87.5
84.4
Skin
10
10
0
100
98.1
Upper Gastrointestinal
3
2
1
50
81.3
Urological
3
2
0.5
75
84.2
60
50.5
5
90.1
88.5
Total
b) By treatment type
Treatment Group
Actual no.
treated
Drug Treatments
Palliative Treatments
Radiotherapy
Surgery
Totals
16
5
10
29
60
Accountable Accountable Poole % National
total treated
total over meeting
%
target
standard meeting
standard
15
0
100
86.2
4.5
1
77.8
92
7
3.5
50
71.8
24
0.5
97.9
90.6
50.5
5
90.1
88.5
Breach reasons
Tumour Type
Upper Gastrointestinal
First First
Wait
Seen Treatment
Report
Days
Trust Trust
Late referral from Poole
RD3
RDZ
74
Haematological
(Excluding Acute
Leukaemia)
RD3
RD3
141
Initially referred from Haem to Head and Neck for further investigations.
Head & Neck
RD3
RD3
84
Complex diagnostic pathway (unknown primary). Patient has been referred across
three specialities.
Lower Gastrointestinal
RD3
RD3
70
Lung
RBD
RD3
117
Upper Gastrointestinal
RNZ
RD3
75
Urological (Excluding
Testicular)
RDZ
RD3
265
Patient was provisionally booked for treatment within target date but initially
declined treatment. On further consideration patient decided to have treatment but
treatment within target was no longer possible.
Late referral from other Trust. Complex patient needed cardiac review to assess
suitability for GA for histological diagnosis.
Oncologist was not available to sign consent form and start radiotherapy within
target date.
Referred from other trust. CARP received 28/1/12 and clinical referral received
16/11/11. Patient delayed many investigations due to holidays and also required a
TURP (not first treatment) to alleviate symptoms.
62 days: Suspected cancer patients detected through national screening programmes
Measure
Maximum 2 month wait from referral from NHS Cancer Screening Programme to treatment by December 2008
Target
90% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
a) Breast
First
Seen
Provider
First
Treatment
Provider
Actual
Total
treated
RD3
RD3
RD3
Total
RBD
RD3
RDZ
7
9
9
25
Accountable Accountable Poole % Median
total treated
total over
meeting Waiting
target
standard
Time
3.5
9
4.5
17
0
0
0
0
100
100
100
100
26
41
25
National
%
meeting
standard
98.8
98.8
98.8
98.8
b) Gynaecological
First
Seen
Provider
First
Treatment
Provider
Actual
Total
treated
RD3
Total
RD3
3
3
Accountable Accountable Poole % Median
total treated
total over
meeting Waiting
target
standard
Time
3
3
0
0
100
100
23
National
%
meeting
standard
100
100
c) Lower Gastrointestinal
First
Seen
Provider
First
Treatment
Provider
Actual
Total
treated
RD3
Total
RD3
1
1
Accountable Accountable Poole % Median
total treated
total over
meeting Waiting
target
standard
Time
1
1
0
0
100
100
55
55
ALL SCREENING PROGRAMMES
First
Seen
Provider
First
Treatment
Provider
Actual
Total
treated
RD3
RD3
RD3
Total
RBD
RD3
RDZ
7
13
9
29
Accountable Accountable Poole % National
total treated
total over
meeting
%
target
standard meeting
standard
3.5
0
100
97.8
13
0
100
97.8
4.5
0
100
97.8
21
0
100
97.8
National
%
meeting
standard
91.9
91.9
Breach reasons
No breaches
62 days: Suspected cancer patients not referred urgently and upgraded by Consultants
Measure
Maximum 2 month wait from consultant upgrade of urgency of a referral to first treatment by December 2008
Target
PCT target - 90%
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
Lower GI
Lung
Totals
Accountable Accountable Poole % National
total treated total over meeting
%
target
standard meeting
standard
7
0
100
92.9
2
0
100
91.2
9
0
100
94
No breaches
62 days: Breast symptomatic referral (non cancer) to first treatment
Measure
Maximum 2 month wait from breast symptomatic referral (non cancer) to first treatment
Target
No standard set
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
MARCH 2012
No patients
Key of Trust Codes:
RBD DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST
RD3 POOLE HOSPITAL NHS FOUNDATION TRUST
RDZ THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST
RHM SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST
RAN ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST
RNZ SALISBURY NHS FOUNDATION TRUST
RA4 YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST
RPY THE ROYAL MARSDEN NHS FOUNDATION TRUST
RBA TAUNTON AND SOMERSET NHS FOUNDATION TRUST
RM1 NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
CWT Trends in performance
PERFORMANCE EXCEPTION REPORT
Diagnostic Access Times: Patients waiting in excess of 6 weeks
The Risk:
There continue to be breaches of the six week diagnostic access target in Endoscopy. This is
primarily due to an increase in referrals, and a backlog developing in the waiting list as a result. This
remains an issue and the Trust is working with the PCT to manage the situation.
Current Position:
The number of patients waiting 6 weeks and above at the end of April is 17 (27 at the end of
March). Of the total number of patients waiting, 95% are waiting less than 6 weeks. The total
number of patients on the waiting list has decreased to 353 (375 at the end of March). This
improved position is partly a false view created by the additional capacity commissioned by the PCT
for the public health campaign, without the anticipated increase of referrals in February. The level of
referrals has since increased, peaking in March. The position has improved despite this increase in
referrals due to the additional lists commissioned by the PCT, as well as three additional lists put on
by the department in March to cover lists closed due to annual leave.
Endoscopy Breaches
120
Number of Patients
100
80
60
Target
40
6+ Endoscopy Waiters
20
0
Jan- Feb- M Apr- M Jun- Jul- Aug- Sep- Oct- N Dec- Jan- Feb- M Apr11 11 ar- 11 ay- 11 11 11 11 11 ov- 11 12 12 ar- 12
11
11
11
12
The Department of Health’s national bowel cancer awareness public health campaign began at the
end of January and finished at the end of March. The campaign was predicted to create demand
equivalent to two extra colonoscopy lists per week for ten weeks, with the greatest increase in
demand for endoscopy expected 4-6 weeks into the campaign. Colorectal referrals have increased
from an average of 43.6 per week in January (before the public health campaign) to an average of
55.25 per week in April. The department continues to monitor the level of referrals on a weekly
basis.
There are emerging issues with the surveillance (planned) waiting list, for which an action plan is in
place. The department is working to eliminate the backlog to ensure we meet JAG accreditation in
September and continues to validate the waiting list. The department is also working to address
ongoing surveillance capacity issues with additional surveillance capacity on a regular basis with a
middle grade doctor and training of a second nurse endoscopist.
Action:
The active waiting list backlog and number of breaches continues to improve. The department
continues to manage the waiting list closely, as well as managing and monitoring referrals. The
department is currently re-assessing department capacity to ensure we’re able to effectively meet
the 6 week wait target, as well as demand for surveillance (planned) procedures.
Laura Bennett
Endoscopy and Bowel Cancer Screening Programme Project Manager
4th May 2012
PERFORMANCE EXCEPTION REPORT
Department:
Delayed Transfers of Care
The Risk:
Delayed Transfers of Care have an adverse effect on patient length of stay and hospital capacity
Current Position:
The percentage of patients formally delayed on the last Thursday of April (DH reporting
methodology) was 2.3%, 1.2% below the Trusts target of 3.5% and the lowest recorded in over two
years.
The majority of delays during April were due to community hospitals (31%), the CHC assessment
process (19%) and self funding patients (33%).
Actions:
A number of actions continue to be implemented and planned to improve delays overall and focus on
the main causes of delays:
•
•
•
•
•
•
The implementation of an integrated approach between the hospital, social services, CHC
staff, community services, including community hospitals will commence during May. Three
phases will lead to the majority of discharge support agencies being located within one area
and working in an integrated way. Phase one will be completed during May which will result
in all social services, the hospital discharge support team and CHC staff being located within
the same area. Daily team meetings will be held between all agencies to review complex
cases and new referrals leading to improved communication and reducing unnecessary
delays
A review of discharge practices within Poole, Bournemouth and Dorchester hospitals is
planned in order to identify further opportunities and share best practice
The trial of a dedicated CHC discharge support worker is planned to commence during May
working in partnership with the PCT in order to give greater focus on reducing unnecessary
delays in gathering evidence and completion of the assessment process
The implementation of the twelve month screening service pilot continues and is expected to
go live during June, supporting a reduction in delays and improvements in discharge planning
overall
In addition to the weekly multi organisational complex discharge meeting a mini review
meeting is planned to commence on a Tuesday morning as part of the daily operations
meetings. The review meeting will focus on all delays but specifically self funding and CHC
patients and work to ensure actions are being progressed as necessary
The Trust is leading the development of a pan Dorset set of reporting principles to ensure
consistent and transparent application of DH guidance
DToC Update May 2012
The percentage of patients formally delayed on the last Thursday of April (DH reporting
methodology) was 2.3%, 1.2% below the Trusts target of 3.5% and the lowest recorded in over two
years. The reduction is associated with a continued improvement in relation to waits for Community
Hospitals, Continuing Healthcare and Intermediate Care. Delays during the first part of May (1st to
11th) have remained at similar levels with 3% of patients delayed.
In line with the above improvements the overall number of bed days lost during April reduced to 480
bed days, a reduction of 12 patients per day compared to the same period during 2011/12.
The number of bed days lost due to self funding patients increased slightly during April to 159 bed
days compared to 149 in March. Focus remains on reducing delays and a new screening service
due to be implemented from June is expected lead to earlier identification of self funding patients
and consequently a reduction in delays.
On average 5 patients per day were delayed waiting for a community hospital during April,
compared to an average of 7 per day during March. A meeting between hospital therapists and the
community hospitals took place recently and actions agreed to further improve the referral process.
The number of patients delayed as a result of the Continuing Health Care (CHC) assessment
process reduced during April to an average of 3 per day, compared to an average of 5 per day
during March. Joint work with the PCT continues and a trial of a dedicated CHC discharge support
worker is planned in order to support ward staff and reduce delays in gathering evidence and
completing the assessment process.
Delays for intermediate care reduced significantly during April with 33 bed days lost compared to
109 during March. The improvement is predominantly due to the new re-ablement service in Poole
and further improvements are expected as capacity is increased to 500hrs per week as planned.
On average 1 patient was delayed each day during April due to social services, the lowest number
of patients recorded in the last 35 months. Increased social services support within the RACE unit is
having a positive impact with further support from Bournemouth social services expected to
commence soon. Poole local authority is planning to commence a weekend service in the near
future further supporting weekend discharge and also 7 day discharge planning.
The majority of delays during April were due to community hospitals (31%), the CHC assessment
process (19%) and self funding patients (33%). A number of actions continue to be implemented
and planned to improve delays overall and focus on the main causes of delays:
•
•
The implementation of an integrated approach between the hospital, social services, CHC
staff, community services, including community hospitals will commence during May. Three
phases will lead to the majority of discharge support agencies being located within one area
and working in an integrated way. Phase one will be completed during May which will result
in all social services, the hospital discharge support team and CHC staff being located within
the same area. Daily team meetings will be held between all agencies to review complex
cases and new referrals leading to improved communication and reducing unnecessary
delays
A review of discharge practices within Poole, Bournemouth and Dorchester hospitals is
planned in order to identify further opportunities and share best practice
•
•
•
•
The trial of a dedicated CHC discharge support worker is planned to commence during May
working in partnership with the PCT in order to give greater focus on reducing unnecessary
delays in gathering evidence and completion of the assessment process
The implementation of the twelve month screening service pilot continues and is expected to
go live during June, supporting a reduction in delays and improvements in discharge
planning overall
In addition to the weekly multi organisational complex discharge meeting a mini review
meeting is planned to commence on a Tuesday morning as part of the daily operations
meetings. The review meeting will focus on all delays but specifically self funding and CHC
patients and work to ensure actions are being progressed as necessary
The Trust is leading the development of a pan Dorset set of reporting principles to ensure
consistent and transparent application of DH guidance
Chris Bailey
Operations Manager
May 2012
PERFORMANCE EXCEPTION REPORT
Trauma Directorate:
Waiting Times for Surgery:
Fractured Neck of Femur within 36 hours of admission (Best Practice Tariff Criteria)
Fractured Neck of Femur within 36 hours of being clinically appropriate for surgery (PCT)
Trauma Patients within 48 hours of being deemed fit for surgery
The Risk:
Fractured neck of femur patients
69% within 36 hours of admission (internal target 90%)
75% within 36 hours of being clinically appropriate for surgery (PCT target 85% April – September
2012 on a cumulative basis and 95% October 2012- March 2013)
97% within 48 hours of being fit for surgery (target 95%)
All trauma patients (including fractured neck of femur)
79% within 24 hours of being fit for surgery
94% within 48 hours of being fit for surgery (target 95%)
The targets being reported against have changed from April 2012. For 2012-12 the PCT initially
included a quality standard that, in line with the Best Practice Criteria, fractured neck of femur
patients should be operated on within 36 hours of admission and they set a cumulative threshold of
85% for the first six months (April-September 2012) followed by a cumulative total of 95% for th
second six months 9October 2012-March 2013). However, this has now been amended to patients
being operated on within 36 hours of being deemed clinically appropriate for surgery, where by the
decision is made by the clinicians as to what is considered to be clinically appropriate. This change
is in recognition of the fact that a percentage of patients will not be fit for surgery form the time of
admission.
The risk remains the ability to meet the clinical standards on a consistent basis month on month
due, in the main, to fluctuations in the number of and case mix of trauma patients admitted.
Current Position:
There were 386 trauma patients admitted in total in April and of these 77 were admitted with a
fractured neck of femur. 76 fractured necks of femur were operated in month, including two patients
admitted at the end of March that underwent surgery on 1 April. Overall, 25 of the fractured neck of
femur patients admitted in March breached the target of surgery within 36 hours of admission. Of
these 7 were deemed unfit upon admission, with 6 of these going to theatre within 36hours of being
considered fit for surgery. The breakdown of breaches is detailed below.
Whilst dedicated theatre time has continued to be made available for fractured neck of femur
surgery on a daily basis, other trauma had to take priority on occasions during the month and the
performance was again affected by the number of fractured neck of femur patients admitted in any
24/48 hour period. As in previous months there were occasions when patients breached the access
targets, whilst at other times there were lists that had some under utilisation. Overall there were
three more fractured neck of femur breaches due to lack of capacity/other trauma taking precedence
than in March. There were a reduced number of lists available on Good Friday and Easter Monday
and whilst the early part of the Easter weekend went well with all surgery being up to date, by Easter
Monday there were issues with managing the clinical priority of patients and on the morning of
Tuesday 10 April there were several fractured neck of femur patients awaiting surgery.
The ideal is to be able to operate on all admissions (unless clinically inappropriate) on the day of or
day after admission and for the patients waiting at home to be admitted on a date advised at the
time of their clinic/ED attendance, or on the following morning. The reinstatement of the second
Saturday list and the two additional weekday lists implemented in January 2012 has helped towards
achieving a slightly more consistent performance than last year.
The graphs at the end of this report show the treatment times for fractured neck of femur and
general trauma patients after they have breached their respective targets.
% Patients Operated on within 36hrs
Number of NOF's admitted
Number of Trauma Admissions
100%
500
% operated within 36hrs of admission
450
80%
400
350
60%
300
250
40%
200
150
20%
78
80
72
68
95
75
100
92
72
79
74
67
77
72
50
0%
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
69%
72%
77%
58%
51%
46%
55%
77%
72%
77%
78%
73%
69%
Number of NOF's admitted
78
68
72
80
75
72
95
67
92
74
79
72
77
Number of Trauma Admissions
357
421
370
394
400
472
435
384
381
364
360
358
386
% Patients Operated on within 36hrs
Patients not fit
pre-op & needed
optimising
Other trauma
cases taking
priority/ran out of
time
Insufficient
theatre capacity
Awaited specialist
surgeon for THR
Awaited for a CT
scan
7
6
10
2
0
Actions:
Phased implementation of the Trauma Business case, which supports the achievement of the
Fragility Fracture best practice tariff and improved access to theatres for all Trauma patients,
commenced in April.
The second Saturday all day list, reinstated on a weekly basis with effect from 7 January 2012,
continued from 1 April 2012 with full funding. The business case included an additional 4 weekday
lists and 2.75 lists per week will commence in May 2012. X-ray facilities will not be immediately
available for these lists, which may on occasions affect their utilisation. The purchase of an
additional image intensifier has been agreed and the increase in radiographer cover approved with
the intention that staffing will be in place by July.
The remaining 1.25 lists are planned for
September, dependent upon the impact of the initial lists, theatre re-scheduling and staff
recruitment. Although initially planned as weekday lists, an analysis of weekend activity to assess
the impact of weekend theatre capacity (2 all day lists Saturday, 1 all day list Sunday) on the access
times following the reinstatement of the second Saturday list is ongoing and this may alter how the
remaining 1.25 lists are scheduled and implemented. The impact of Bank Holiday operating hours is
also under review.
All NOF breaches are being looked at in detail in order to establish the cause, decisions taken
further changes that can be made to reduce further the number of breaches that occur.
Yvonne Hunter
Directorate Manager
11 May 2012
NOFs - Treatment Times for Patients Breaching the 36 hour Target: April 2011 - April 2012
36-48 hours
2-3 days
3-4 days
> 4days
30
20
15
10
5
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
Month
Non NOFs: Treament times for Patients Breaching the 48 Hour Target: April 2011 - April 2012
2-3 days
3-4 days
4-5 days
>5 days
16
14
12
Number of Patients Breached
Number of patients Breaching
25
10
8
6
4
2
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Month
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
PERFORMANCE EXCEPTION REPORT
Stroke : Target: ≥80% of patients should spend > 90% of their LOS on the Stroke Unit
The Risk: The Trust failed to meet this target in March but met the target in April..
Current Position:
67.5% of patients spent > 90% of their LOS on the Stroke Unit in March (target ≥ 80%).
82.1% of patients spent 90% of their LOS on the Stroke Unit in April (target ≥ 80%).
The following table indicates the number of stroke patients admitted and the % that achieved the target in the
previous 3 months.
No. of stroke pts admitted
% of patients should spend
> 90% of their LOS on the
Stroke Unit
Jan
43
81.4
Feb
38
68.4
Mar
40
67.5
Apr
56
82.1
Stroke admissions remain high with a continuing increase in activity year on year.
MARCH
We experienced a high volume of D&V (Norovirus) effecting both patients and staff during late February and
early March, despite stringent infection control measures, patient areas were closed, necessitating changes to
accommodate the Stroke pathway on various wards during the month.
This in turn meant that March saw the Stroke pathway being re-designated to RACE unit from the end of
th
th
th
th.
February until March 6 and over the weekend of March 24 & 25 until the reopening of ASU on the 26 This
was due to D&V causing further bed closures on ASU. The Stroke pathway was managed successfully by
allocating a thrombolysis trained Nurse to RACE during these times as well as ensuring that nursing and AHP
colleagues followed patients on the RACE unit, allowing delivery of appropriate to continue.
Further hospital wide bed pressures during March forced patients to be moved off the acute unit when safe
and appropriate to do so to accommodate hyper acute patients, others remained as outliers or in alternative
appropriate beds within DME. This also meant that there was limited capacity with Stroke if being utilised for
non-stroke patients.
In March there were a number of cases of patients being diagnosed with a Stroke during their hospital stay,
different to the original admission diagnosis. This means they may remain outliers, or be transferred to the
ASU too late to reach target.
One patient was lost due to timings being recorded in days not hours this month as he remained in ED until
late evening, transferred to ASU after midnight, and discharged 48 hours later. Had we recorded in hours this
would have been over 90%, in days this reduced us down to below target.
APRIL
April saw a 29% increase in Stroke admissions, with 82.1% of patients spending more than 90% of their time
on the Stroke unit.
The Stroke pathway remained on ASU for the month, there were no bed, bay or ward closures and flow of
patients around the site remained efficient and allowed best use of Stroke beds.
100% (6/56) of patients suitable for thrombolysis were seen and thrombolysed within 1 hour (door to needle).
There were incidents during March & April that have been highlighted to the Stroke team concerning some
patients who were admitted with a diagnosed Stroke were not sent directly to ASU. These patients were sent
to other wards as outliers or were sent to RACE when beds were, or could have been, made available on
ASU. This is being investigated further.
Actions against the review of the business continuity plan continue, with conversations taking place about
Stroke beds and management of pathways during times when the unit is closed. This may require
investigation into movement of designated Stroke beds on the unit to allow for closures of individual bays or
cubicles, if required, without impacting on wards or compromising the Stroke pathway.
Actions:
1. The business continuity plan will be further reviewed and developed to provide more robust support of the
management of stroke admissions during periods when access to designated stroke beds is compromised
to ensure appropriate patient management.
2. Ward processes continually reviewed. Staffing and skill mix managed appropriately during times of
sickness.
3. Discussions about reconfiguration of beds continue.
Barry Duell
Associate Directorate Manager
Medical Division (DME, Diabetes & Rheumatology)
th
18 May 2012
PERFORMANCE EXCEPTION REPORT
Theatre Services Utilisation Measurement
The Risk:
Day Theatre under-utilisation
Current Position:
Day Theatre reached 77% utilisation for April 2012
Working on the potential operating time available for each list based on the number of cases
2 patients excluding team brief and turnaround time – 92%
3 patients - 89%
4 patients – 86%
5 patients – 82%
6 patients – 79%
Based on these levels of activity it is impossible for every list to achieve 85% as any list with three
patients or more is already unable to achieve the target.
With the adjusted figures based on the above matrix day theatre utilisation reached 80%
Total patients booked = 443
Patients episodes completed = 432
Four sessions were under booked which equated to 190 mins = 0.9 session or 3-4 patients
Six patients cancelled unfit on the day which equated to 360 mins = 1.7 sessions
One patient cancelled no paed bed which equated to 40 mins
Four patients DNAs which equated to 178 mins
Whilst there are still lost opportunities on the day theatre lists, all of the above mentioned reasons
for underutilisation have improved on March 2012 figures
Actions:
Action plan put in place in March 2012 is continuing to be actioned and reviewed.
Vivian Stevens
Head of Theatres
May 2012