Dr Anne Talbot

GP & Urgent Care Clinical Lead, Bolton CCGAssociate Medical Director, Service Transformation, Greater Manchester

Supporting urgent care using clinical dashboards: transforming data into knowledge

An overview of the Urgent Care Clinical Dashboard concept (including dashboard screenshots)

The local implementation approach

The project’s current position Benefits Success factors and key messages

Presentation Overview

The dashboard collates the previous day’s urgent care activity data and brings it all together in a user-friendly graphical display, integrated with GP practice data

GP practice staff may access the dashboard on their desktops via secure login. District nurses and active case managers can be given access for practices they work with

Clinicians can drill down to a more detailed patient-level view

Each dashboard is clinically-driven and locally led. Sites can use existing technology to build their dashboard, keeping costs down and increasing flexibility

The Urgent Care Clinical Dashboard Concept

A&E AttendancesPatient Attendance DatePatientA 01/09/2012PatientF 01/09/2012

PatientJ 02/09/2012PatientM 03/09/2012PatientJ 04/09/2012

PatientK 03/09/2012

AdmissionsPatient Admission DatePatientA 01/09/2012

PatientH 04/09/2012PatientK 08/09/2012

DischargesPatient Discharge DatePatientA 08/09/2012PatientK 08/09/2012

Walk in CentrePatient Attendance DatePatientM 01/09/2012PatientF 01/09/2012PatientJ 02/09/2012PatientM 03/09/2012PatientJ 04/09/2012

PatientK 08/09/2012

PatientK 03/09/2012

Out Of HoursPatient Contact DatePatientT 01/09/2012PatientY 01/09/2012PatientJ 02/09/2012

PatientM 03/09/2012PatientJ 04/09/2012

PatientK 02/09/2012

Practice Disease RegisterPatient RegisterPatientT Diabetes

PatientS CHD

PatientK COPD

Before the Dashboard

Information From Acute Trust

Information From Practice

Information received separately

from multiple sources within different time

frames – making identifying patterns

difficult

Integrating sources of information

Patient Attendance DatePatientA 01/09/2012PatientF 01/09/2012

PatientJ 02/09/2012PatientM 03/09/2012PatientJ 04/09/2012

Patient Admission DatePatientA 01/09/2012

PatientH 04/09/2012

Patient Discharge DatePatientA 08/09/2012

Patient Attendance DatePatientM 01/09/2012PatientF 01/09/2012PatientJ 02/09/2012PatientM 03/09/2012PatientJ 04/09/2012

Patient Contact DatePatientT 01/09/2012PatientY 01/09/2012PatientJ 02/09/2012

PatientM 03/09/2012PatientJ 04/09/2012

Practice Disease RegisterPatient RegisterPatientT Diabetes

PatientS CHD

PatientK

Dashboard:Patient Drilldown - PatientK

Service Attendance Date Register?

PatientK

PatientK PatientK

PatientK

PatientK

PatientK

08/09/2012

03/09/2012

02/09/2012

08/09/2012

08/09/2012

03/09/2012

WiC

OOH

Discharge

Admission

A&EA&E

Admission

A&E

Discharge

OOH

WiC

COPD

COPD

COPD

COPD

COPD

COPD

COPD

Information From Acute Trust

Information From Practice

Integrating sources of information

The original Bolton dashboard

Devon dashboard

Cambridgeshire dashboard

Brighton & Hove dashboard

Brighton & Hove dashboard – risk

Brighton & Hove – drilldown

How Bolton use the dashboard

Individual patient level

Practice operational level - identifies issues of primary care access

Locality operational level - identifies poor patient pathways, areas of training need across professional groups

Locality strategic level - tool linked to strategic aims, objectives and plans; A&E frequent attender initiative, hospital readmission initiative, public media campaign

Dashboard-enabled change;practice level

Locality level; A&E attendances over time

Bolton CCG readmission initiativePractices were asked to use the Clinical Dashboard to identify all their discharges, contact these patients within 48 hours of discharge and follow up on any problems identified.

29.8% reduction in 24 hr readmissions 15.5% reduction in 48 hr readmissions Positive patient feedback

Implementation approach

Project scoping (4

weeks approx)

Project delivery (10

weeks approx)

Pilot go-live (4 weeks approx)

Wider rollout and review (ongoing)

Benefit and Change Management

Clinical Metrics and Safety

Technical

Information Governance

Project Management

Engagement and Communication

Training

Structure provided to local teams through an implementation guide and toolkit available on NHS Networks. This provides templates, guides, standard metrics, data feed specifications to enable rapid progression.

Early checks to ensure that key elements for a successful implementation are addressed. These include: clear clinical leadership and engagement with the GP

community; assessment of the technical landscape and approach for

sourcing data and delivering the dashboard; Information Governance approach; and the creation of the clinical group to review and agree

the metrics for inclusion on the dashboard

Implementation approach

Typical urgent care metricsTitle Description

Urgent Contact numbers by service by time period

Provides number of patient contacts at each of the various local, unscheduled care services yesterday, last 7 days and last 30 days

Urgent Contact numbers time series (by service or aggregated)

Provides number of patient contacts at each of the various local, unscheduled care services as a timeline over the last 30 days

Urgent Contact numbers time series with comparison to previous year

Provides a comparison of this year’s activity with the same period last year

Urgent Contact numbers by time-bands

Provides details of the spread of urgent care contacts during a 24hr period

Urgent Contact numbers comparison between GP Practice and Peer Group

Provides a comparison for each GP Practice of the urgent care activity for their patients compared to an agreed peer group’s activity (e.g. CCG or like Practices by Demographic)

Urgent contact numbers grouped by number of contacts

Provides a view of the numbers of patients with a given number of contacts in the given time period e.g. 10 patients with 3 contacts in last 7 days

Patient list by highest urgent contacts

Provides list of patients typically by NHS Number who have the most frequent contacts in the last 7 days.

This is supported by a number of drill down views to enable clinicians to see patients’ details, the nature of urgent care contacts and supporting information like risk scores (from a risk stratification module) and disease register information.

KEYSites with live dashboards Sites in implementation phaseFurther scheduled dashboard deployments

NHS Stoke on Trent and NHS North Staffordshire

NHS Devon

NHS Torbay

NHS Plymouth

NHS Tees (NHS Hartlepool, NHS Middlesbrough, NHS Stockton-on-Tees, NHS Redcar & Cleveland) NHS Gateshead

NHS County Durham and Darlington

NE Lincolnshire Care Trust Plus and partners

NHS Calderdale

NHS Northamptonshire

NHS Leicester City, NHS Leicestershire County and Rutland

NHS Cambridgeshire

NHS Peterborough

NHS Luton

NHS North Essex

NHS Suffolk

NHS Oxfordshire

NHS Southampton

NHS Buckinghamshire

Central London Healthcare Partnership

NHS Bolton

South Cheshire and Vale Royal GP Commissioning Consortia

NHS Merseyside (NHS Liverpool, NHS Halton & St Helens, NHS Knowsley, NHS Sefton)

NHS Manchester

NHS Central Lancashire

Lancaster Morecambe Carnforth & Garstang CCG

NHS Oldham

NHS Tameside & Glossop

NHS Trafford

NHS Brighton and Hove

NHS East Sussex Downs and Weald

Medlinc CCG/NHS Surrey

Dashboard implementation sites

32 sites now have a live Urgent Care Clinical Dashboard. The dashboard is available to over 1000 GP practices, and covers a patient population of around 6.3 million. This will increase to 2000+ practices and 13.5 million patients when sites currently implementing complete their rollout to GP practices

Early implementers are adding further content to their dashboards, e.g. risk scoring, additional data feeds (e.g. ambulance), a pseudonymised organisation-wide view, yearly activity comparisons

Refined implementation toolkit, templates, tools and guide available to all at our NHS Networks site: www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp-dashboard

Dashboard User Group established, run by sites for sites

Current position: dashboard project

Emergent benefits at live dashboard sitesReduced A&E attendancesReduced/prevented Emergency/Non-Elective admissionsShorter stay for some patients in unscheduled care via earlier, supported dischargeReduced prescribing wasteMore timely information on attendances, admissions, & discharges, enabling more proactive careEnables quicker and improved support for hospitalised patientsIncreased awareness of data quality issues from unscheduled care settingsImproved communication between clinicians from different teams/organisationsIncreased awareness of unscheduled care activity of patients resident in care homes and for patients with long-term conditions

Increased visibility of:• touch points within patient pathways•inappropriate unscheduled care attendances during practice hours• patients who will benefit from active case management• primary care access issues• (for GP practices) how they perform compared to peer practices/consortium average• spend against budget at practice/locality level• unscheduled care activity for commissioning support staffIncreased identification of opportunities for patient education re: use of unscheduled care

Critical success factors

Demand led clinical

leadership

Access to ‘Best Practice’

Clinical Leadership:•Demand led (not pushed)

•Local clinical ownership during project and beyond

•Executive level sponsorship

Improvement Capabilities:•Dashboards are a tool not the solution

•Clinical change management and improvement support to drive benefits

•Linking dashboard to local improvement initiatives

Access to best practice:•Encourage sharing and reuse

•Successful projects will lead to more success

•Repeatability and lower risk

Local InformaticsCapability:

•Information available from source systems

•Reasonable understanding of Business Intelligence solutions

•Moderate capability to transform and manipulate information to generate metrics

Informatics Capability

Improvement mindset and capabilities

Lessons Learned/Key Messages It’s never too early to engage

with clinicians, data providers, or IG leads

Keep focusing on the benefits which the dashboard will deliver

Often, simplest is best Use the resources and support

available; someone has probably solved your problem already!

The dashboard is an enabler; it’s what you do with the information it provides that makes the difference

Any questions?

clinical.dashboard@nhs.netwww.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp-dashboard

QIPP Digital Technology:Working with national and local teams to

exploit digital technology in order to accelerate delivery of their QIPP priorities

http://www.networks.nhs.uk/nhs-networks/qipp-digital-technology-and-vision

qippdt@nhs.net