Winter planning helps hospitals deal with demand

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Plans put in place for winter have meant Shropshire’s two acute hospitals have so far coped better than last year.

A report which will go before the Board of The Shrewsbury and Telford Hospital NHS Trust (SaTH) this week says that the Royal Shrewsbury Hospital (RSH) and the Princess Royal Hospital (PRH) in Telford saw a reduction in breaches of the national four-hour Accident and Emergency Department (A&E) waiting time target in the two week Christmas to New Year period.

The Trust implemented its internal Winter Plan at the end of November 2015. As part of that plan 44 surgical beds were temporarily reassigned as medical beds across both sites, with elective orthopaedic work being provided through a mobile day surgery unit at PRH.

The report says:

• Overall A&E attendances remained broadly the same as 2014/15

• Breaches of the national four-hour A&E standard at RSH decreased by 17.7% against a rise in attendances of 6%

• The number of patients aged 75 and over attending ED is about the same as last year, however the number of those admitted from A&E has risen by 5%

• There has been a 15.9% fall in the number of deaths compared to the same period of time last year

• In the first week of January 2016, despite very high demand, only 13 patients had their elective procedure cancelled in comparison to 31 the previous year

The report notes that the Trust had to implement its “Hospital Full Protocol” on four consecutive days from 3-7 January. However, thanks to the hard work of staff, the escalation level – which reflects the current status of the hospitals in terms of bed availability and level of emergency demand – was reduced from Level 4, on 4 January, to Level 2 on 7 January. Last year the Trust was on Level 3 throughout the winter period.

Debbie Kadum, Chief Operating Officer at The Shrewsbury and Telford Hospital NHS Trust, said: “We know the peak winter period is a busy one for hospitals up and down the country, and we are no exception.

“We took steps following last winter to ensure that lessons were learned and many of those worked well over the Christmas and New Year period.

“The plan runs until mid-March so it is too early to assess its full impact at this stage, and we will make sure we do not get complacent. We will take the learning from this plan forward as we prepare for the Easter Bank Holiday.”

The Trust Board will be told that during December, more than eight out of every 10 patients seen by the Trust’s A&Es was admitted, transferred or discharged within four hours. During that time, emergency attendances were up 3.17% compared with December 2014. Overall there has been an increase of 6,645 attendances between April and December – a rise of 6.77% on the year-to-date.

Although the Trust did not meet the national 95% standard, plans are in place to reduce the number of people waiting for a long time in A&E.

As part of the plan, eight additional cubicles were opened at PRH on 12 January and new processes are being designed to support timely clinical decision making at PRH to ensure that the new cubicle capacity is used to best effect. Work is also on-going on improving patient flow by reducing the average time it takes to process patient medication by 50%.

In the run-up to winter, the NHS Emergency Care Improvement Programme (ECIP) was invited to carry out a review of the whole local health economy to help identify areas to improve patient flow. The team acknowledged that SaTH was struggling with the resilience of the Emergency Departments due to a significant number of consultant vacancies, but said they were encouraged to see the Departments using Emergency Nurse Practitioners (ENPs) and Advanced Nurse Practitioners (ANPs) following recent investment.

The Trust is currently undertaking a business continuity plan to ensure the continued safe, effective and dignified running of Emergency Services.

As part of that contingency planning, SaTH leaders – including Doctors, Nurses and support staff – have met with healthcare partners and patient representatives to look at what scenarios should be considered should a “tipping point”, where safe services could no longer be maintained, be reached. These included the possible, temporary overnight closure of one of our two A&E Departments at some point in the future.

Debbie said:

“We continue to work to ensure these tipping points are not reached, and it was encouraging to hear the recognition from ECIP about our work with ENPs and ANPs.

“However, we must continue with our continuity planning to ensure that we can continue to provide safe, effective and dignified care for our patients.”

ENDS

Notes for Editors:

For more information contact David Burrows, Communications and Engagement Officer at The Shrewsbury and Telford Hospital NHS Trust, on 01743 261378.