Managing Elective Care

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Managing Elective Care

• Alan Pye
• Operations Manager
• South Devon Healthcare NHS Trust

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Introduction

• A brief history as to why we did this
• What we have learned from the exercise
• The things we are able to pass on to other trust
  and things that you can do

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Introduction

• We were struggling with getting our elective
  admissions, whilst managing emergencies and
  trying to maintain patient flow.
• Medical Outliers were occupying elective beds
• Surgeons complaining about Medicine blocking beds
  and Medical Consultants on safari ward rounds
• Elective patients being brought in earlier just
  to ensure a bed.

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Some Solutions

• We wanted to bring elective patients on the day
  but this was causing problems on the wards
• Find an alternative area to admit the patients
• Go to theatre from there
• Could walk to theatre
• Admitting ward could concentrate on discharging
  the previous patients
• More time for the patient
• Process Map the process

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Process Mapping can be overdone
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Findings

• High daily variation in elective admissions
• Peaks on Tuesday
• Low numbers on Friday
• Weekend emergencies blocking Mondays admissions

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Theatre Re-design

• Traditionally this has been done to maximise
  every theatre list with little regard to beds
• Look at maximising day surgery
• Installation of new Trauma theatre
• Concentrating the emergency into a designated
  CEPOD theatre
• Template each list to type of patient

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Virtual Ward
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There is only one flow
Inpatient
Flow is dependent on Exit strategies
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Improving Patient Flow

• How do we measure Patient flow.
• Definition of a delay.
• Any period of time where the no value added to
  the patients treatment plan.
• How to this monitor delay.
• What is and is not acceptable in terms of delay.

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Whirlpools Eddies
Disturbances in the flow
Troubleshoot to maintain the flow
We need to map the process to find the problems
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Use the Data

• You have masses of Historical Data
• Present it in simple form
• Give Clinicians their own data
• Let that data do the selling
• Bin the fancy that data

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Tips

• Need to identify the beds as early as possible
• Need to have the surgeons / anaesthetist engaged
  in the process
• Have to have confidence in the Bed Manager

Love your Bed Manager
Need to manage the flow
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Dont Go on Leave