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6 Essential Actions to Improve Unscheduled Care

The programme will continually seek to share best practice and engage partners across NHSScotland and wider UK, and evaluate impact of the 6 Essential Actions to deliver unscheduled care target and compliance with national standard. A full programme of networking and sharing of best practice and innovations will be implemented across 2015-16.

Essential Action 1 - Clinically Focussed and Empowered Hospital Management

This Essential Action is about the Clinical Leadership and operational management of basic hospital and facilities, determining appropriate staffing levels linked to activity, creation of clear escalation policies and appointment of an appropriate site director alongside medical and nursing chiefs of staff and duty managers across all services and targets. This is central to what we do around performance and management on a day to day basis within our acute sector hospitals and working across a whole system approach.

Essential Action 2 – Hospital Capacity and Patient Flow (Emergency and Elective) Realignment

This will establish and then utilise appropriate performance management and trend data to ensure that the correct resources are applied at the right time, right place and in the right format. The initial work will establish a current footprint of flow into, through and out of the hospital to identify where capacity meets or does not meet demand. It will examine where solutions such as streaming and high volume specialty pathways will improve flow and the hidden consequences of altering current systems.

Wider work in this area will centre around producing a combined elective and emergency capacity plan for each of the major sites as well as promoting increases in day-case surgery, for example.

Essential Action 3 – Patient Rather Than Bed Management – Operational Performance Management of Patient Flow.

This Essential Action will examine processes that follow and facilitate the patient journey (flow) rather than about bed management. A key outcome will be focussed on coordinated planning and implementation of appropriate discharge without delay. This includes focus on early morning and weekend discharge. This will require engagement with all departments such as laboratory, pharmacy and allied health professionals as well as discharge lounges and transport services.

This workstream is basically all about effective patient tracking through the pathway and is about operational management grip and control. From an unscheduled and scheduled care point of view, and from a patient centred point of view. These aspects should be coordinated to ensure optimum focus on effective discharge.

Essential Action 4 – Medical and Surgical Processes Arranged to Improve Patient Flow through the Unscheduled Care Pathway

This Essential Action will ensure that internal hospital departments are geared with appropriate links to pull patients from the Emergency Department (for example, assessment units and acute receiving wards) with appropriate workforce and job planning to ensure that this becomes a reality. This action should ensure that there is prompt access to appropriate assessment and clinical intervention from specialists in the appropriate environment to enhance patient experience and establish care management plans promptly, minimising unnecessary waits and delays wherever possible.

Essential Action 5 – Seven Day Services Appropriately Targeted to Reduce Variation in Weekend and Out of Hours Working

We already have a national programme for Seven Day Services led by a Task Force of clinical and operational experts and the Unscheduled Care programme will align itself closely to this, supporting priorities that improve unscheduled care. The priority will be to reduce evening, weekday and weekend variation in access to assessment, diagnostics and support services focused on where and when this is required to: avoid admission where possible, shift emergency to urgent care, reduce length of stay, and improve weekend and early in the day discharges safely.

The activities of the seven day task force will also support aspects of Essential Actions 3 and 4.

Essential Action 6 – Ensuring Patients are Optimally Cared for in their Own Homes or Homely Setting

This essential action will consider how someone who has an unscheduled care episode can be optimally cared for, or discharged to their own home, as soon as possible.

This work will align to other portfolios of work ongoing to enhance self-management and longer term focus on preventative care and improvements in access to self-directed care and enablement services for complex conditions and comorbidity will be supported by the introduction of Integrated Joint Boards and community care developments.

Managing the patient journey to promote living well and dying well at home includes a focus on patient led self-care and improved communication between the whole system health care team.