DISCHARGE PROGRAMME BOARD PERFORMANCE REPORT April …

DISCHARGE PROGRAMME BOARD PERFORMANCE REPORT

April 2016

Table of Contents Page SECTION ONE: Governance Structure 3

SECTION TWO: Dashboard 4 - 12

SECTION THREE: Improving Discharge Workstream 13 - 18

a) Highlight Report b) Exception Report

SECTION FOUR: Discharge Hub Workstream 19 - 22

a) Highlight Report b) Exception Reports

SECTION FIVE: Discharge to Assess 23 - 25

a) Highlight Report

SECTION SIX: Issue Log 26 - 28 Risk Register 29 - 30

PMO Document v0.6: Y:\ERYCCG\Shared Report & Data\PMO 2\Programme Areas\Discharge\Governance

Delivering Effective Discharge Programme Governance Structure

EO Emma Owen MH Moira Harrison

JC Jo Cooper ER Ellen Ryabov

JH Jane Hawkard SH Stacy Healand

JM Julia Mizon SJ Steve Jessop

KR Karen Richardson TCo Theresa Cope

RJ Richard Johnson TC Tracey Craggs

DE Denise Everett YE Yvonne Elliot

Discharge Hub (Lead: YE

Discharge to Assess (D2A) (Lead: TC)

Delivering Effective Discharge Programme (Lead: JH)

Systems Resilience Group

Unplanned Care Programme

Planned Interventions

Programme (PIP)

Trusted Decision Makers Model Implementation

(Lead: MH/JC)

Implementation of D2A Model (Lead: EO)

Data Intelligence (Lead: RJ)

Improving Hub Processes (Lead: DE)

Community Beds Utilisation Management

(Lead: JM)

Reduced LoS for Complex discharge within 4 days of MFFD/EDD

(Lead: DE)

In-Hospital Programme

Non-Complex (Simple) Discharge

(Lead: ER)

Reducing Length of Stay (LoS) for Simple Discharges

(Lead: ER)

Roll-out of Exemplar Ward (Lead: DM/SH)

Process Improvement/Improving flow – Nurse Led Discharge

(Lead: SH)

Community Beds (Lead: TCo/YE)

Implementation Single Operating Model

(Lead: DE)

Community Hospital Discharge (Following final assessment /MFFD not >1

day post EDD (Lead: JM)

3

Section One

Baselined Daily Average 84 84 84 84 84 84 84 84 84 84 84 84 84 84

Target (baseline -10%) 50 50 50 50 50 50 50 50 50 50 50 50 50 50

Actual Daily Average 74 76 92 88 85 86 86 75 78 86 84 94 93 96

87 95 114 95 92 99 100 88 86 101 100 119 107 135

Win/Loss 24 26 42 38 35 36 36 25 28 36 34 44 43 46

Baselined Daily Average 40 40 40 40 40 40 40 40 40 40 40 40 40 40

Target (baseline -10%) 24 24 24 24 24 24 24 24 24 24 24 24 24 24

Actual Daily Average 28 34 32 30 29 35 41 29 27 35 28 29 34 28

Win/Loss 4 10 8 6 5 11 17 5 3 11 4 5 10 4

Data SourceData source is the progress to discharge summary report and only those that are identified as a formal delayed transfer of care (DTOC SITREP). Patients ready

for discharge with a length of stay greater than 7 days, daily average for the reported week.

Commentary

Against the national DTOC reporting, the system has seen a consistently high number of patients waiting over 7 days. Denise Everett from City Health Care

Partnership to report on the Root Cause Analysis (RCA) of patients waiting longer than 7 days for discharge. A process is in place where every patient with a

LOS > 7 days is reviewed Monday, Wednesday & Friday and blockages to discharge addressed.

Tota

l>7

day

sDischarge Board - Dashboard Headline Measures

Indicator 1 - Medically fit for discharge (10% reduction on baseline)

Indicator 2 - Length of stay, once medically fit for discharge

Commentary

Data Source

The number of patients waiting over 7 days continues to be above the trajectory. The threshold for total discharges has been reduced to 50 and those over 7 days to 24 in line

with the plan from September 2015. From the 3rd January 2016, the Safer Start to 2016 and the MADE events commenced. The number of MFFD on Cayder increased due to

the proactive identification of MFFD patients. In addition 27/12/15 and 3/1/16 were extended Christmas/New Year when there was reduced resources to support discharge.

Discharge hub; data manully extracted from Cayder at 1000 hours daily. Baseline is daily average of those MFFD during June and July 2015. Targets are a 10% reduction of the

baselined activity.

Highest no: MFFD in week

0

50

100

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

Total

<7 days

>7 days

Target Total

Target >7days

4

Section Two

Data Source Data is sourced from the weekly community beds data

Discharge Board - Dashboard Headline MeasuresIndicator 3 - Community bed capactity, utilisation (bed days)

CommentaryBed occupancy has dropped by 0.7% from the previous week but is just above the 90% threshold for week commencing 20th March 2016 at 90.3%.

* For week commencing 20th March 2016, data was not collated for the 26th March 2016, therefore only 6 days were reported.

5

Section Two

Discharge Board - Dashboard Headline MeasuresIndicator 4 - Morning Discharges by week

CommentaryThe data continues to demonstrates significant underachievment of this target. For week commencing 20th March 2016, 17.5% of patients were discharged

during the morning across the trust, 19.4% for medicine and 14.2% for surgery. HEY continue to provide ward level data for morning discharge.

Data SourceData sourced from Hull and East Yorkshire Hospitals NHS Trust. Daily data converted to a weekly average. No retrospective data available. Target set to 30%

of morning discharges on each ward base.

283 215 262 242 304 249 264 270 274 283 287 271 281 272

1278 1156

1311 1297 1321 1351 1265 1355 1300 1284 1323 1392 1290 1280

0%

10%

20%

30%

40%

0

500

1000

1500

2000

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

All wards

AM PM % AM Target

113 96 111 102 130 99 93 113 123 113 127 110 109 104

479

381 440 443 446 456

389 466 460 441 465 462 421 433

0%

10%

20%

30%

40%

0

200

400

600

800

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

Medical wards

AM PM % AM Target

6

Section Two

Data Source Unify2 Data Collection - MSitDT. February 2016 data available on 14th April 2016.

Discharge Board - Dashboard Headline MeasuresIndicator 5 - Delayed Transfers of Care at HEYHT (Delayed Days)

CommentaryFor June 15 and subsequent months the data may be incomplete, due to the implementation of Lorenzo (patient record system) at Hull and East Yorkshire

Hospitals Trust. The split where the delay occured by Social Care and both (i.e. Social Care and NHS) was not recorded prior to June 15.

819 880 880

711 713 589

756

582

756

242 161

75 152 103

237 260

539 18 94

65 66

21

62

263

197

98 62

51

98

95

35

89

49

358 317

191

316

219

334

612

785

0

200

400

600

800

1,000

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

NHS Social Care Both

7

Section Two

Total Total Total Total Total Total

138 22 15.9% 168 12 7.1% 36 12 33.3% 180 2 1.1% 206 4 1.9% 225 5 2.2% 8.8%

124 31 25.0% 112 10 8.9% 121 2 1.7% 150 3 2.0% 145 4 2.8% 145 56 38.6% 8.5%

246 22 8.9% 224 50 22.3% 232 16 6.9% 240 14 5.8% 232 19 8.2% 232 14 6.0% 9.3%

554 29 5.2% 504 19 3.8% 522 42 8.0% 540 27 5.0% 510 31 6.1% 522 90 17.2% 4.2%

948 13 1.4% 868 6 0.7% 899 5 0.6% 900 0 0.0% 899 0 0.0% 899 6 0.7% 0.7%

527 12 2.3% 476 14 2.9% 493 18 3.7% 510 0 0.0% 476 5 1.1% 493 10 2.0% 2.2%

372 87 23.4% 332 128 38.6% 348 99 28.4% 360 50 13.9% 348 97 27.9% 348 73 21.0% 22.2%

930 111 11.9% 840 34 4.0% 840 24 2.9% 900 0 0.0% 870 7 0.8% 870 4 0.5% 4.8%

368 143 38.9% 336 38 11.3% 348 62 17.8% 360 9 2.5% 348 39 11.2% 348 105 30.2% 17.2%

4207 470 11.2% 3860 311 8.1% 3839 280 7.3% 4140 105 2.5% 4034 206 5.1% 4082 363 8.9% 6.6%

ICT Hull Health Beds Bridlington

YTD

ICT Hull Health Beds Rose Villa

ICT Hull Health Beds Highfield

Hull CCG : Social Care Use Thornton Court

Hull CCG : Social Care Use Castle Rise

Provider

Hull CCG : Social Care Use Rossmore

Hull CCG : Social Care Use St Mary'

Feb-16

Improved Discharge Board - Dashboard Headline Measures

KPI1 - Community Bed Utilisation

Oct-15 Nov-15 Dec-15 Jan-16

Unoccupied

Mar-16

Unoccupied

IHT Humber Health Beds East Riding Community Hospital

Unoccupied Unoccupied Unoccupied Unoccupied

IHT Humber Health Beds Withernsea

Totals

Data is taken from the Discharge Summary report. Total bed days available across 11 providers vs those that are unoccupied each month.Data Source

Commentary For the month of February 2016, 6.3% of beds were unoccupied, year to date 9.4%


Commentary

KPI5 - Checklist to Home in less than 10 days KPI3 - Proportion of morning discharges (monthly)

BI Team, CHCP & BI Team HEY

Checklist to home in less than 10 days has increased to 87.9% in December 2015.The proportion of AM discharges has dropped slightly to 17.3% in February 2016.

BI Team, HEY Data Source

Commentary

Data Source

0.00%

10.00%

20.00%

30.00%

40.00%

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

% AM % AM Target

30 29 36

14 29

5 8 11

2

4

85.7% 78.4% 76.6% 87.5% 87.9%

0%

20%

40%

60%

80%

100%

0

20

40

60

80

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

=< 10days >10 days %=<10 days

8

Section Two


Data Source

CommentaryChecklist to DST has continued to achieve the threshold in January 2016 with all 19 completed within

48 hours achieving 100% of the 95% target.

BI Team, CHCP

KPI 6 - Checklist to DST – 48 hours

77.8% 88.9%

70.4%

100.0% 94.1%

100.0% 100.0%

0%

20%

40%

60%

80%

100%

0

10

20

30

40

50

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Same/next day 2 - 3 days 4+ days %same/next Target

9

Section Two

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

113 96 111 102 130 99 93 113 123 113 127 110 109 104

479 381 440 443 446 456 389 466 460 441 465 462 421 433

19.1% 20.1% 20.1% 18.7% 22.6% 17.8% 19.3% 19.5% 21.1% 20.4% 21.5% 19.2% 20.6% 19.4%

67 30 55 53 63 65 67 56 63 57 63 56 67 68

374 322 394 409 413 387 377 413 358 390 389 403 402 412

15.2% 8.5% 12.2% 11.5% 13.2% 14.4% 15.1% 11.9% 15.0% 12.8% 13.9% 12.2% 14.3% 14.2%

95 79 91 72 104 80 93 92 84 89 80 99 100 96

363 394 394 378 407 448 431 400 415 386 412 466 394 361

20.7% 16.7% 18.8% 16.0% 20.4% 15.2% 17.7% 18.7% 16.8% 18.7% 16.3% 17.5% 20.2% 21.0%

8 10 5 15 7 5 11 9 4 24 17 6 5 4

62 59 83 67 55 60 68 76 67 67 57 61 73 74

11.4% 14.5% 5.7% 18.3% 11.3% 7.7% 13.9% 10.6% 5.6% 26.4% 23.0% 9.0% 6.4% 5.1%

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

226 185 225 169 245 200 199 207 217 194 222 215 221 201

962 907 971 949 976 1018 928 989 999 959 992 1031 927 942

19.0% 16.9% 18.8% 15.1% 20.1% 16.4% 17.7% 17.3% 17.8% 16.8% 18.3% 17.3% 19.3% 17.6%

57 30 37 73 59 49 65 63 57 89 65 56 60 71

316 249 340 348 345 333 337 366 301 325 331 361 363 338

15.3% 10.8% 9.8% 17.3% 14.6% 12.8% 16.2% 14.7% 15.9% 21.5% 16.4% 13.4% 14.2% 17.4%

283 215 262 242 304 249 264 270 274 283 287 271 281 272

1278 1156 1311 1297 1321 1351 1265 1355 1300 1284 1323 1392 1290 1280

18.1% 15.7% 16.7% 15.7% 18.7% 15.6% 17.3% 16.6% 17.4% 18.1% 17.8% 16.3% 17.9% 17.5%

% AM Discharges for Hull and East Yorkshire Hospitals NHS Trust by ward type (all wards)

Week commencing

% AM Discharges for Hull and East Yorkshire Hospitals NHS Trust by site and trust (all wards)

AM Discharge

PM Discharge

Hull Royal Infirmary

AM Discharge

AM Discharge

PM Discharge

Ward type

Site

% AM Discharge

% AM Discharge

Castle Hill Hospital

Hull & East Yorkshire Hospitals NHS

Trust

Family & Womens Health

PM Discharge

Medicine

AM Discharge

PM Discharge

% AM Discharge

Clinical Support Services

AM Discharge

PM Discharge

% AM Discharge

Surgery

AM Discharge

Week commencing

% AM Discharge

PM Discharge

AM Discharge

PM Discharge

% AM Discharge

% AM Discharge

10

Section Two

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

H1 Medicine General Medicine HRI 20.9% 21.1% 10.0% 9.7% 19.4% 14.5% 10.6% 14.9% 11.1% 14.3% 26.9% 13.1% 7.7% 2.5%


H11 Medicine Stroke Medicine HRI 11.1% 18.2% 13.6% 35.7% 26.3% 15.4% 4.5% 33.3% 22.2% 0.0% 28.6% 11.1% 12.5% 10.0%

H110 Medicine Stroke Medicine HRI 26.1% 15.8% 0.0% 16.7% 16.7% 11.1% 12.5% 6.7% 0.0% 5.3% 5.3% 23.5% 15.4% 11.1%



H200 Medicine General Medicine HRI No patients No patients No patients No patients No patients No patients No patients No patients No patients No patients No patients No patients No patients No patients

H5 Medicine Respiratory Medicine HRI 17.9% 34.6% 29.2% 35.7% 20.0% 0.0% 36.8% 21.1% 13.0% 17.6% 28.6% 10.0% 28.0% 28.6%

H50 Medicine Nephrology HRI 4.5% 7.7% 0.0% 22.2% 20.0% 0.0% 33.3% 36.8% 4.5% 16.7% 8.7% 14.3% 14.3% 15.4%

H500 Medicine Respiratory Medicine HRI 18.4% 18.2% 26.1% 35.0% 26.7% 18.2% 15.0% 15.4% 25.0% 21.9% 33.3% 21.9% 33.3% 26.1%

H70 Medicine Geriatric Medicine HRI 3.6% 22.7% 12.1% 16.7% 9.4% 4.3% 8.3% 12.9% 16.0% 20.7% 4.0% 10.0% 8.3% 25.8%


20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016


19.5% 28.0% 20.8% 21.0% 20.4% 19.4% 17.1% 21.5% 18.1% 19.6% 26.1% 16.7% 18.9% 20.3%

H100 Surgery Gastroenterology HRI 16.7% 4.3% 0.0% 3.6% 14.3% 14.3% 14.3% 5.0% 8.7% 5.0% 9.5% 24.1% 11.8% 15.8%

H4 Surgery Neurosurgery HRI 0.0% 5.7% 11.8% 6.8% 7.3% 9.5% 9.7% 7.7% 2.7% 0.0% 0.0% 2.4% 11.9% 0.0%

H6 Surgery General Surgery HRI 4.3% 7.8% 14.0% 7.4% 7.3% 5.3% 14.6% 13.2% 12.5% 5.1% 22.0% 11.1% 7.7% 9.1%

H60 Surgery General Surgery HRI 21.4% 3.8% 13.3% 2.4% 17.9% 10.3% 17.1% 6.3% 8.7% 5.8% 6.8% 15.8% 15.6% 3.2%

H7 Surgery Vascular Surgery HRI 16.7% 9.1% 3.0% 11.1% 3.0% 13.0% 6.7% 0.0% 9.4% 20.7% 0.0% 4.2% 6.3% 10.0%

H9 Surgery Trauma & Orthopaedics HRI 33.3% 33.3% 36.8% 20.0% 41.2% 10.0% 46.2% 25.0% 0.0% 27.3% 25.0% 30.8% 46.7% 30.8%

H90 Surgery Trauma & Orthopaedics HRI 31.6% 23.1% 25.0% 28.6% 30.8% 16.7% 22.2% 42.9% 58.8% 33.3% 23.5% 0.0% 28.6% 25.0%

17.1% 9.3% 15.1% 9.8% 15.8% 11.5% 18.9% 13.4% 13.9% 9.9% 12.2% 13.5% 16.7% 11.0%

C29 Clinical Support Services Rehabilitation CHH 100.0% 100.0% 0.0% 50.0% 16.7% 33.3% 0.0% 66.7% 8.7% 0.0% 33.3% 0.0% 100.0% 0.0%

C30 Clinical Support Services Clinical Oncology CHH 10.0% 8.3% 5.3% 13.3% 0.0% 0.0% 0.0% 0.0% 0.0% 6.3% 21.1% 7.1% 6.7% 6.7%

C31 Clinical Support Services Clinical Oncology CHH 11.1% 15.4% 13.3% 7.7% 25.0% 13.3% 0.0% 14.3% 11.1% 12.5% 22.2% 14.3% 8.3% 0.0%

C32 Clinical Support Services Clinical Oncology CHH 0.0% 5.9% 6.3% 33.3% 0.0% 0.0% 12.5% 4.5% 7.1% 7.1%

11.6% 13.2% 8.3% 20.8% 8.8% 7.3% 4.1% 10.2% 6.8% 9.6% 27.3% 10.0% 7.5% 4.7%

Selected medicine wards (Total)

Selected surgery wards (Total)

Selected clinical support services wards (Total)

% AM Discharges for Hull and East Yorkshire Hospitals NHS Trust (all wards)

Ward Type Speciality Site

% AM Discharges for Hull and East Yorkshire Hospitals NHS Trust (selected wards)Week commencing

0.0%

20.0%

40.0%

20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016

Medicine Surgery Family and Womens Health Clinical Support Services HRI CHH HEY Target

11

Section Two

12

Section Two

IMPROVING DISCHARGE WORKSTREAM

Lead: Ellen Ryabov

13

Section Three

HIGHLIGHT REPORT - Improving Discharge Project

FOR IMPROVING DISCHARGE BOARD:

26 April 2016

LEAD: Ellen Ryabov OVERALL PROGRESS Vs PLAN: Under Control Risks identified with a recovery

plan in place

Summary of achievements in reporting period Key actions for progress in coming calendar month

Plan refined with proposed KPIs and key Milestones drafted, which incorporates and aligns to the SRG deliverables

5 wards per month Rollout Plan drafted – to align with other PMO internal activities

SAFER Bundle and supporting products under development to ensure consistent offering to all wards; will include standard bundle with additional tools to address specific areas for improvement where needed

Monthly Steering Group meetings established

MADE Event held (wards H5, H500, H12, H120) – 23rd

March 2016

Working with Commissioners to align activity reporting

Project 4: Delivery plan to be finalised

Project Rollout Plan to be agreed and commenced

SAFER Bundle and supporting products to be agreed and standardised

Monthly Steering Group monitoring project delivery against plan

Review feedback from MADE Event 23rd

March 2016

SPMs to visit Ipswich to review their red/green working in practice and how this links

to board rounds, SAFER principles and trigger tools for escalation

Progress against KPIs

KPI This month’s achievement Recovery actions (if required) Included in Exception Report to Board? (Y/N)

KPI 1: Reduction in medical outliers

Aligned KPIs to U&ECP P4: Reducing Waits and Improving Discharge

Trajectories to be set once baseline data agreed for KPIs listed and risks to be identified – Project Steering Group meeting on 11.04.16

N

KPI 2: Reductions in stranded patients



N

KPI 3: Robust clinical plan and EDD within 24 hours



N

KPI 4: Delivering flow through demand and capacity modelling



N

KPI 5: Reduction in LoS Aligned KPIs to U&ECP P4: Reducing Waits and Improving Discharge


N

KPI 6: Facilitating early morning flow - 30% increase in morning discharges (monthly) in medicine bed base



N

14

Section Three

KPI 7: Patients who are medically optimized for discharge should make up less than 3% of the total acute bed base (22 patients)



N

KPI 8: No patient on the delayed list for more than 7 days



N

KPI 9: 95% achievement of agreed standards across all modalities



N

KPI 10: Implementation of the SAGER Patient Flow Bundle



N

Key Risks (Score 12 or over) Recommended Actions Probability/ Likelihood score

Impact/Severity score

Overall Risk score Included in Exception Report to

Board? (Y/N)

To be agreed

Description of Issue Recommended Actions

Completed by: Rachel Craven / Donna Dudding Signed off by: Agreed with Rachel Craven at meeting on 07.04.16

Organisation: HEYHT Organisation: HEYHT

Date: 07.04.16 Date: 07.04.16

15

Section Three

Programme Name: Priority Measure: Morning DischargesProgramme Lead: Reporting Date: Apr-16Dashboard Summary of Performance: Recovery Action Plan/Options: No update for April 2016

KPI Target Latest PeriodLatest

PositionRAG KPI Target Latest Period

Latest

PositionRAG

Proportion of morning

discharges (monthly)

Specific Wards

30% Jan-16 13.5% 0KPI3 - Proportion of morning

discharges (monthly)

All wards

30% Jan-16 15.7%

Improving Discharge ProjectEllen Ryabov

CHART GOES HERE CHART GOES HERE

Data Source: AM discharges (showing only non-elective admissions),ERY patients only. Exclusions : pateints marked as deceased are excluded from the dataset

Data Source: AM discharges (showing only non-elective admissions) ,ERY patients only. All Wards Exclusions: patients marked as deceased are excluded from the dataset

16

Section Three

Recover Action/Options Expected Impacts Impact Date RAG

MADE Events and 'Safer Start 2016 currently underway. Piloting new

processes on Wards H5, H9 and H12 until end January to identify and

remove barriers to discharge with all partner agencies; potential to roll

out wider across Trust if outcome is positive.

If pilot successful, a multi-agency approach will speed up discharges by:

• All agencies working to same EDD (Med Fit date)

• No rejection of Section 2s

• Therapies to list rehab goals and not rehab ‘potential’

• Social Care pre planning for discharge and not waiting until discharge date

• Social Care to advise patients of appropriate package of care following assessment and not

Medics to pre-determine. Following completion of pilot, H9 reported initiative made a

positive impact on ward efficiencies to discharge. Need to consider agreeing formal process

to continue this arrangement and roll out across Trust.

To commence

February 2016a

a

Using Service Improvement and Lean methodologies to develop a

standard set of tools and processes (Board Rounds, The SAFER Bundle,

EDD, PREDICT, Ticket Home)

The 'Safer Start 2016' documentation mirrors those developed in conjunction with the IDP

and Improvement Academy work; therefore ensuring a standard approach across the Trust.

As project progresses, need to continuously audit to ensure that improved practices are

maintained and sustained.

Ongoing a

Develop the ‘exemplar discharge ward’ so that the new processes can be

spread across the Trust to ensure there is a consistent effective approach

to discharge practice across the organisation utilising the SAFER Bundle

and ‘Predict’ tool.

Improving Discharge Project : The key KPIs are:

o 0.5 day reduction in baseline ward average Length of stay (50% reduction on >14 day

stays, 20% reduction in >7 day stays)

o 30% morning discharge rate

o 20% weekend discharge rate

• Current workstreams on H9 and H80 have not yet achieved the desired improvements and

therefore, plan is behind schedule but PMOs continue to investigate further improvements.

Ongoing

17

Section Three

18

Section Three

DISCHARGE HUB WORKSTREAM

Lead: Yvonne Elliott/Denise Everett

19

Section Four

HIGHLIGHT REPORT - Discharge Hub FOR DISCHARGE BOARD: April 2016

LEAD: Denise Everett OVERALL PROGRESS Vs PLAN: AMBER

Summary of achievements in reporting period Key actions for progress in coming calendar month

1. SOP finalised for HUB partners in line with Cayder changes. 2. SOP embedding commenced and consolidation for all patient flow charts at

10am morning meeting. 3. DTOC action plan will be progressed. 4. Task & Finish group commences for Escalation & Choice Policy review 5. Task & Finish group commences for System wide single assessment. 6. Daily DTOC reporting will be progressed.


KPI This month’s achievement Recovery actions (if required) Included in Exception Report to

Board? (Y/N)

Key Risks (Score 12 or over) Recommended Actions Probability/Likelihood score

Impact/Severity score

Overall Risk Score Included in Exception report to

Board? (Y/N)

Potential risk to the effectiveness of single operating procedure due to organisations not following process

Nominated key lead for each organisation in the HUB who will be responsible for embedding the SOP in their teams Embedding of the cascade of key pathway at ward level so no confusion as to role and function of hub with regards to complex discharge for patients

3 3 9 N

Description of Issue

Recommended Actions

None Identified

Completed by: Denise Everett Signed off by: Yvonne Elliott

Organisation: CHCP

Date: Date:

20

Section Four

Programme Name: Priority Measure: Indicator 2 - Length of stay, once medically fit for dischargeProgramme Lead: Reporting Date: April 2016

Dashboard Summary of Performance: Recovery Action Plan/Options:

KPI TargetLatest

PeriodLatest Position RAG Recover Action/Options Expected Impacts Impact Date RAG

Indicator 2 - Length of

stay, once medically fit

for discharge (complex

discharges)

0 patients

> 7 days

w/c

20/03/2016

17 (> 7 days) 9

(14-29 days)

2 (> 30 days)R

Deviation Description

Discharge HubDenise Everett

See Chart Below

21

Section Four

Programme Name: Priority Measure: Medically fit for discharge (10% reduction on baseline)Programme Lead: Reporting Date: April 2016

Dashboard Summary of Performance: Recovery Action Plan/Options:

KPI TargetLatest

Period

Latest

PositionRAG Recover Action/Options Expected Impacts Impact Date RAG

Medically fit for

discharge (10%

reduction on baseline) of

complex discharges

24 patients

> 7 days

w/c

20/03/201628 R

Deviation Description

Discharge HubDenise Everett

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Section Four

DISCHARGE TO ASSESS WORKSTREAM

Lead: Tracey Craggs

23

Section Five

HIGHLIGHT REPORT - Discharge to Assess Programme FOR DELIVERING EFFECTIVE DISCHARGE BOARD:

April 2016

LEAD: Tracey Craggs

OVERALL PROGRESS Vs PLAN: Off-Track

Summary of achievements in reporting period

Key actions for progress in coming calendar month

1. Evaluation from PDSA of first D2A patient commenced, data still being gathered verbal report to D2A/Hub work group 06/04/16

2. Innovation workshop for D2A Implementation planned on hold until outcome of options appraisal received

3. Development of Pathway 2 for first patient for D2A to be discharged completed 4. Commenced PDSA on second patient for D2A discharged on Pathway 2 planned

identification of patient for Pathway 2 pilot was for w/c 04/04/16 currently delayed due to suitable community bed availability

5. Patient feedback received from Pathway 1 to be added to evaluation

1. Options appraisal to be completed and presented to Discharge Board for extra capacity/resources to deliver full model roll-out

2. Decision for progression to Business Case or closure of project from Discharge Board following options appraisal presentation

3. Evaluation report 4. Separated project plans for each pathway to be developed in more detail for

development and service leads to be identified once outcome of options appraisal is clear

5. Testing of patient satisfaction questionnaire and information leaflet, and further development of these based on feedback received through Pathway 2 testing


KPI This month’s achievement Recovery actions (if required) Included in Exception Report to

Board? (Y/N)

Key Risks (Score 12 or over) Recommended Actions Probability/Likelihood

score Impact/Severity

score Overall Risk

Score Included in

Exception report to Board? (Y/N)

Non identified

Description of Issue

Recommended Actions

Capacity and resources for outreach ‘wrap around’ services to deliver D2A model in full identified by stakeholders

Report presented to Discharge Board in March an Options Appraisal to be developed and presented to Discharge Board in April with view to full business case if continuation of project agreed.

24

Section Five

Completed by:

Emma Owen Signed off by: Tracey Craggs

Organisation:

ERYCCG ERYCCG

Date:

04/04/16 Date: 06/04/16

25

Section Five

Produced by NYHCSU on behalf of East Riding of Yorkshire CCG

Work Stream Name: Discharge Hub

Ref Description of Issue Comments (to include

Originator and date raised)

Priority* Assigned To (who is responsible)

Target Date

Action/Outcome/Decision Category**

Status***

1DH Discharge Hub Coordinators role- The job description and person specification has been to the panel for banding and has come back as an 8A and not an 8B. The board have advised that there needs to be an interim staff member in post before LWa leaves.

14/09/15 Christy Francis

P2 Christy Francis 01/10/15 CF is to relook at the job description and person specification. An interim to backfill LWa’s post needs to be in place.

13/10/15 Update: Job advertised and interim in place.

Scope/Quality Closed

Work Stream Name: Improving Discharge Group

Define process for project as now reporting to two boards (Closed 10.03.16)

Ellen Ryabov 10/3/2016 Action to be undertaken: Revise project realigning to Urgent and Emergency Care

Closed

Project is 5 weeks behind schedule for rollout die to SPM leave and resource, reallocation to establish U&ECP. Project will be superseded by U&ECP for at least 10 months. Agree new date to handover H9 and H80in light of U&EC Programme Board and new governance structure

Ellen Ryabov 10/3/2016 Project 4 reducing waits and Improving Discharge. H5 Respiratory and H90 Department of Elderly Medicine to commence from 14/03/2016 in line with ECIP Concordat. H9 and H80 to be handed over to service as business as usual 1

st April 2016.

Being reviewed

2IDG Lorenzo Therapy referral protracted (24 clicks vs. 3 click)

15/09/15 Ruth Colville

P3 Ellen Ryabov 20/10/15 Software patch currently in development and in testing stage.

09/10/15 Update: Deployment now expected 20/10/15

Update 06/11/15 Lorenzo 3-step Therapies referral extension (delayed due to failure)/ ongoing testing and development. Associated ‘Risk’ removed as not being managed within the project

Time Being reviewed

Improving Discharge Programme Issues Log February 2016

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Section Six


being managed within Information Services.

4IDG Launch of CAYDER virtual wards

delayed

13/11/15 P3 Ellen Ryabov TBC I believe this may have been addressed by Steve Jessop and implemented but can’t be 100% sure.

Scope/Quality Being reviewed

3IDG Staffing Shortfalls 15/09/15 Ruth Colville

P3 Ellen Ryabov All posts are actively reviewed and must pass through Trust Vacancy Control Panel. Active overseas recruiting efforts for Nursing posts. OT and Physiotherapy services have a cross competency training programme to make more flexible use of resource within existing staff. Radiology, SLT actively attempting to recruit subject to controls.


1IDG Lorenzo reporting insufficient 15/09/15 Ruth Colville

P3 Ellen Ryabov Manual snapshot audits being conducted to from baseline in therapy response times.

13/10/15 Update: Risk Closed


Work Stream Name: Discharge to Assess

Capacity and resources for outreach ‘wrap around’ services to deliver D2A model in full identified by stakeholders

15/02/2016 Tracey Craggs Report and business case to be developed and presented to Discharge Board on 22

nd March.

3D2A The scope of the sub programme is to be redefined. Some of the projects that had been allocated to the D2A sub programme originally have now been reviewed and identified as needing to sit either in the Discharge Hub or In-hospital programme or are discharge related matters to be managed via the contract management process.

03/11/15 P3 Tracey Craggs 24/11/15 Agreement is required from the programme board lead and the SRG Director of the projects now contained within the sub programme.


1D2A Change in required model of beds from spot purchase to block contract identified week commencing 02/09/15. Has required changed specification and engagement agreement of wrap

07/09/15 Tracey Craggs

P2 Claire Strawbridge 30/11/15 Specification has been changed resulting in delayed implementation

Time Closed

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Section Six


around services from key stakeholders and will put the implementation back.

2D2A The Business Intelligence support to the sub programme is leaving to take up another post in 4 weeks’ time. There is no identified replacement resource identified.

17/09/15 Tracey Craggs

P3 Richard Dodson 01/11/15 Escalation to Discharge Board 22/09/15 Scope/Quality Closed

*Priority: **Category: ***Status:

P1 = project work must stop until the problem is resolved P2 = project work will soon fall behind schedule if the problem is not resolved P3 = the project will continue without a disruption

Scope/Quality Time Budget

C=Closed O=Open D=Deferred

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Section Six

Ref Date identified Risk Event

Probability

of Risk

Recommended

Action

Risk

Owner Status

(dd/mm/yy) (Description) (Likelihood)

(Accept/Transfer

/Reduce) (Closed/Open/Deferred)

IDG8 13/11/2015

Engagement of junior medics in

board rounds and early

completion of IDLs, identifying

discharge to location on IDLs /

communicating with Pharmacy

Improving

Discharge

Work Stream

failure to

deliver Possible 15

Clarify roles and responsibilities with Clinical Leads, work with

Pharmacy to explore improvements, training needs (Controlled

Drugs, Anticoagulation) (3/5=15). 27/11 Roles and

responsibilities drafted (Rco/RMC, W80 agreed. (Now links

with Risk IDG11) Reduce ER Same 14/12/2015 Being reviewed

IDG9 10/03/2016

Engagement of junior medics in

board rounds and timely

completion of IDSs Likely 12

In discussion with Pharmacy to understand barriers Drs face

when completing IDS and also new guidance re Lorenzo to be

rolled out w/c 11/01/16. Updated: extending due dates as

further meeting pending with Pharmacy (links with Risk IDG8) ER Same 10/03/2016 Being reviewed

IDG10 10/03/2016

MADE events highlighting

barriers to discharge by internal

culture - patients/families

refusing to leave hospital due to

social matters when they no

longer have an acute need and

should be discharged (bed

blocking) Likely 12

Consider assertiveness training for nursing staff to tackle

patients and families refusing to leave. SPM exploring options

with Alyson Newlove (Legal Dept) regarding effectively

managing 'bed blockers'. Escalation policy needs to be actively

implemented. ER Same 10/03/2016 Being reviewed

IDG11 10/03/2016

Urgent and emergency care

programme will draw on HIP

PMO resources in the short - mid

term

Almost

Certain 10

Agreement of mid-long term strategy for delivery per revisions

necessitated by ECIP Concordat ER Same 10/03/2016 Being reviewed

DH3 11/12/2015

Potential risk to the

effectiveness of single operating

procedure due to organisations

not following process

Discharge Hub

Work Stream

failure to

deliver Likely 9

Nominated key lead for each organisation in the HUB who will

be responsible for embedding the SOP in their teams.

Embedding of the cascade of key pathway at ward level so no

confusion as to role and function of hub with regards to

complex discharge for patients. Reduce DE New 11/12/2015 Open

Controls and Mitigation Movement Date Last Reviewed

PROJECT LEAD: Emma Owen

Risk Score

Catastrophic

Moderate

Moderate

Moderate

Minor

SPONSOR/SRO: Jane Hawkard

(Impact)

PROJECT START DATE: 01/04/2015PROJECT END DATE: 01/04/2016

Severity

Impact

Description

RISK LOGPROJECT NAME/REF: PMO Discharge ProgrammePROGRAMME AREA: Discharge Programme

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Section Six

D2A1 09/10/2015

Implementation of Intermediate

Tier (Time to Think) beds not

completed by 1/10/15 for

ERYCCG.

Beds on line from 7/12/15 Risk

score reduced to reflect

Failure to

deliver within

agreed time

frames

Almost

Certain 9

Agree revised implementation date of 07/11/15. Confirmation

of funding for beds to enable procurement to progress. Accept CS Down 07/12/2015 Closed

IDG5 10/06/2015

Baseline data delayed due to

implementation of Lorenzo

Improving

Discharge

Work Stream

failure to

deliver Serious 20

Note high level LoS data available for H500 / H8 until HRG

breakdown is available. T Sowersby committed to providing

resource as soon as possible. Data may be another 3-4 weeks

(19/06/15) . 17/07/15 awaiting HRG data. Information Services

and Business Intelligence teams are now working to provide but

data not yet available. Lorenzo reporting may be delayed

further as not clinical priority. Corporate Information Teams

aware and will prioritise after issues with clinical impact fully

resolved. 11/9/15 HRG comparisons and LoS >7 >14 > 30 days

received and used to inform Exemplar Ward Rollout proposal.

Therapy referral to response reporting remains outstanding – Accept RC / TS Same 13/11/2015 Closed

IDG6 09/10/2015

Staffing shortfalls – across all

disciplines remain a risk.

Radiographers & Radiologists

compromising short and long

term plans.

Improving

Discharge

Work Stream

failure to

deliver Possible 15 Reduce SB Same 13/11/2015 Closed

IDG7 09/10/2015

Lorenzo referral process

protracted due to system issues

impacting national spine at

implementation. This is

impacting productivity on wards

due to time it takes to complete

referral process.

Failure to

deliver within

agreed time

frames Possible 15

Reverted to 24-click referral process while development

solution is pursued. Solution is in testing phase but has yet to be

deployed.

9/10/15 Deployment scheduled for 20/10/15

Reduce SB Same 13/11/2015 Closed

Almost Certain

Catastrophic

Catastrophic

Moderate

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Section Six

DISCHARGE PROGRAMME BOARD PERFORMANCE REPORT April …

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