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Cross-system care is the way forward

It would seem impossible for a hospital to be running at more than 100 per cent occupancy of emergency medical beds.

But, in fact, this is the case at both Glasgow Royal Infirmary (GRI) and the Queen Elizabeth University Hospitals (QEUH)... and at the Royal Alexandra Hospital, it runs at 97.5 per cent occupancy.

The ideal we should aim for to ensure resilience and capacity peaks is 85 per cent.

At the GRI and QEUH, occupancy levels of more than 100 per cent are achieved by using beds that should be for planned activity. The result is pressure on emergency departments, patient waiting time targets being missed and, ultimately, the need to cancel some planned activities.

Media commentators and, indeed, some of our own staff, speculate that we have simply got the bed model wrong.

Deputy medical director Dr David Stewart has been working with a wide range of clinical colleagues both in our acute hospitals and in the community to analyse the issues and ultimately “crack the problem”.

His conclusion is that more beds and more staff is simply not the answer… bed numbers are not the problem at the root of our performance issues.

Presenting his findings to the Board, Dr Stewart delivered a very upbeat message: “We have identified that there is a very significant opportunity to improve our performance against national targets and deliver better care to patients.

“We currently admit more patients from emergency department (ED) to hospital beds than other comparable boards in Scotland. Even allowing for deprivation levels in our communities, the admission rates are very high.

“At first it might seem that our clinical teams are inappropriately admitting patients. But the main conclusion is that our ED and acute medical teams simply don’t have enough appropriate alternatives to offer.

“In short, we need to develop a bigger menu of options as alternatives to hospital admission… and urgently deliver the aims of the 2020 vision outlined in the National Clinical Strategy for Scotland and the Health and Social Care Plan.

“The integrated pilot project at the RAH in Paisley is delivering proof that collaboration with health and social care colleagues and acute unscheduled care teams at the front door of the hospital makes a real difference.

“We need to build on and fine-tune front-door triage and assessment models. We need to work with care homes to avoid unnecessary acute admissions. We need more alternatives to admissions and to help patients avoid unnecessary admission to hospital.

“Cross-system primary care, social care and acute care is the only way we can deliver for our patients and improve our performance against the four-hour emergency department target to see, assess, treat and admit or discharge.

“Much of this work is already under way. We have exemplar wards in our hospitals driving up efficiencies in timely discharge, improved prescription regimes and new doctor rounds protocols. A frailty pilot at the QEUH is also showing some really positive results.

“Now we have identified what needs to be done, we can accelerate the process to deliver the changes that will deliver for our patients and our performance targets.”

Dr Stewart’s mantra is: “No one in a hospital bed who doesn’t need to be there.”

The full detail of Dr Stewart’s presentation is persuasive and hugely encouraging. Staff will be able to see him present the detail on an exclusive staff Webex to be broadcast later in August. Watch out for details in your Core Brief and StaffNet Hot Topics for the date and the details.

Cross-system care infographic figures - small  Cross-system care emergency admissions - small  Cross-system care alternatives to admission - small  

Cross-system care attendance - small