Stobill to GRI The Staffing Challenges and Improvements

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1 Stobill to GRI The Staffing Challenges and Improvements Alan Hunter General Manager, Emergency Care & Medical Services North East Sector and Cardiology Wednesday 28 th November

2 Recession/CRES Great timing! Hospitals On The Edge/Fractured Care Planning and Juggling Greater Front Door Presence Day Job or Project Team OP Activity WTGs/Junior Doctor Reductions Acute Care Physicians Additional beds - Staffing

3 (a) Ground work Stobhill/Virtual GRI (b) Medical Boarding (c) (d) Surgical GP Referrals Fast track through A&E Acute Physicians (e) (f) Smoothing of Twin Peaks and focus on discharge and internal patient flows Endless debates/option appraisals and massive activity analysis exercise time of day and location specific (g) Front door -v- Out Patient activity -v -specialty/site turf wars (ongoing Job Planning Implications)

4 Additional Beds (a) 32 AAU cubicles were a replacement for Stobhill Casualty and RAS (GRI & Stobhill) A&E couldn t be extended (b) 35 Additional beds - front door/specialty and weekend priorities v- maintaining Outpatient activity (Juniors) (c) (d) 6 bedded medical HDU a first for GRI and stobhill Continued focus on discharge/ length of stay reduction i.e. don t breath out No Additional consultant or junior medical staff

5 PRE ASR Move Inpatient Emergency Admissions (12 months prior) Attendances Medicine Surgery All specialties GRI A&E Stobhill Casualty & Minor Injury Unit Total PRE ASR Activity Post ASR Move Inpatient Emergency Admissions (12 months post) Attendances Medicine Surgery All specialties GRI A&E GRI AAU (GP Referrals) Stobhill MIU Total POST ASR Activity ,304* 12,050** *40% GP referrals not admitted compared to 25% prior to changes ** Urology, Vascular & Renal Services transferred from GRI to WIG

6 MEDICAL RESOUCES PRE AND POST MERGER WITH A&E/E.D. Front Door' Medical Hours (excl. consultants) per week Medical staff include junior Pre Move Post Move doctors in training FY2 - ST3+, GRI ED 1404 GRI ED 1578 associate specialists, staff grades Stobhill Casualty 647 Stobhill MIU 0 and clinical assistants etc Stobhill MIU 0 GRI AAU

7 Pre Consultant Daily Input into Receiving GRI 2 Consultant ward rounds x 2 consultants Stobhill 2 consultant ward rounds x 1 consultant Total 3 consultants Post Move consultant daily input into Receiving 2 consultant ward rounds x 5 consultants Weekend Cover Pre move Post move 3 consultants 6 consultants

8 GRI & Stobhill Pre IP Merger Home Stobhill GP, 999 & Self Attendees Stobhill Casualty Receiving Wards Stobhill ACH GRI Minor Injuries Rapid Assessment Service for GP Referred Patients GRI A&E GP, 999 & Self Attendees Home Receiving Wards Direct Admissions to Downstream Wards

9 GRI & Stobhill Post Merger Stobhill ACH Minor Injuries Unit Virtual Ortho Clinic SPECIALTY SPECIFIC Medical Receiving AMRU/HDU/Cardio/CCU GRI EDIS 1 Surgical GP Referred, Self Referred, 999 & Self Attendees A&E Home/PIAA Fast Track Surgical Receiving Wards Triage GP Referral Medical Patients Triage Acute Assessment Unit AAU EDIS 2 Home/PIAA Downstream Ward

10 Glasgow Royal Infirmary 4 Hour Compliance Jan 2011 to October % 98% 96% 94% 92% 90% 88% 86% 84% 82% Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12

11 Total patients discharged home from AAU % - prior to redesign was 25% GRI Acute Assessment Unit Top 8 Diagnostic Categories of Patients Discharged Home from AAU 12 month dataset Oct 11 - Sept 12 Chest Pain 22% Other Categories 34% Angina 2% DVT/?DVT 18% Cellulitis 2% Accidental / Intentional Poisoning 3% Respi r ator y 10% ( / ) Gastr o-intestinal 5%

12 GLASGOW ROYAL INFIRMARY - MONTHLY BREAKDOWN OF BREACH REASONS Not Know n 98 Other reason 7 Clinical reason(s) 6 Wait for 1st assessment 5 Wait for diagnostics test(s) 4 Wait for initial A&E treatment 3 Wait for a specialist 2 Wait for transport 1 Wait for bed Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12