Trust Board Integrated Performance Report 6 th May 2010 | 0
NUH at a Glance 1 Legend / key Forecasts R A G Shows whether next month’s position will meet the standard Data Quality indicator Not sufficient Judgment of Executive Director Granularity Completeness Validation Timeliness Audit Source Sufficient Exemplary Not yet assessed | 1
Escalation pages (1/4) Successful Choose and Book appointments Indicator level 1 % of successful Choose and Book referrals to appointments booked via the Telephone Appointment Line, over number of TAL slots What is driving the reported underperformance? What actions have we taken to improve performance? ▪ General reduction across services ▪ Ophthalmology - A referral refinement pathway for NHS of slots availability over the Easter Nottingham City went live on 4 th Jan and NHS Notts County bank holiday period. referral pathway will live by 30 th April 2010. A triage service ▪ Ophthalmology – impact of went live from March for Nottingham City PCT – limited significant increase in referrals success made date. following the change in Royal ▪ ENT: Shortage of specialised staff. New staff due to College referral guidance. commence in post over period of the next 2 months. ▪ Work continues with PCTs to redirect appropriate referrals into the appropriate community based service. Referral criteria are agreed and the pathways for the Nottingham Back Care Team, Pain Management and Spinal Service have now also been agreed. Breaches of the 28 day readmissions guarantee Indicator level 1 % patients whose operation was cancelled, by the hospital, for non-clinical reasons, on the day of or after admission, treated within 28 days What is driving the reported What actions have we taken to improve performance? underperformance? • Bed and theatre capacity ▪ Standard March 96% 91% YTD Forecast A 91% Expected date to meet standard September 2010 Lead Director Standard March 5% 9. 4% Michelle Rhodes YTD Forecast 7. 8% A Weekly reviews of reasons for cancelled operations is highlighting any emerging trends. This is enabling appropriate actions to be taken, for example reviews of theatre scheduling Expected date to meet standard July 2010 Lead Director Michelle Rhodes | 2
Escalation pages (2/4) Screening all day case patients for MRSA Indicator level 2 Screening of all day case patients for MRSA; exclusions currently includes Children, Radiology, ophthalmic, Routine Obstetrics, Termination of Pregnancies, Pain management, Endoscopy, Minor Dermatology What is driving the reported underperformance? ▪ Certain areas continue to develop systems and practices to allow screening of all day cases ▪ Due to screening and clinical coding data there is a two month gap which may not reflect improvement made until later data is released Standard 90% March 75% YTD Forecast N/A What actions have we taken to improve performance? ▪ Underperforming areas identified and being performance managed via the Infection Control Operational Group ▪ Clinical Leads have developed Action plans to ensure greater compliance in future months Expected date to meet standard Lead Director Screening all emergency patients for MRSA Indicator level 2 Screening of all relevant emergency admissions for MRSA 'Relevant emergency admissions' is currently defined as excluding all children What is driving the reported underperformance? ▪ Stephen Fowlie Standard 90% March 58% YTD N/A Forecast A What actions have we taken to improve performance? ▪ June 2010 ▪ This does not become a reportable national target until 31 st December 2010 Currently NUH screens all emergency patients admitted to surgical wards. At present there is not the lab capacity to process the increased swabs to extend to other clinical inpatient areas Work is being undertaken to ensure that the lab capacity is in place. Once completed clinical areas will be asked to commence screening all emergency admissions Expected date to meet standard December 2010 Lead Director Stephen Fowlie | 3
Escalation pages (3/4) Diagnostic waiters (number waiting 6 weeks and over) - as reported in QDIAG Indicator level 1 # patients waiting over 6 weeks for diagnostic procedures in endoscopy, imaging, pathology and physiological measurement What is driving the reported underperformance? ▪ Visual electo diagnostic - Ophthalmic Science - Delayed referral due to Admin error ▪ Nerve conduction test Neurophysiology. Delayed referral received from Kings Mill Standard March 0 2 YTD Forecast N/A What actions have we taken to improve performance? ▪ Admin and process procedures reviewed and amended to avoid any recurrence ▪ Issue has been taken forward with Kings Mill for them to ensure systems are reviewed and revised Expected date to meet standard Lead Director Indicator level Primary Angioplasty within 150 mins 1 Patients receiving Primary Angioplasty within 150 mins What is driving the reported underperformance? ▪ This is a jointly owned target with EMAS and the long delays for March have been experienced in the call to door times not door to perfusion What actions have we taken to improve performance? ▪ We will be operating a 24 hour service in September before which we are planning to work with colleagues at a 'productive cath lab‘ ▪ A project manager has been appointed to start in May. ▪ We will instigate regular performance meetings with our colleagues from EMAS as we plan to move towards full operational 24/7. ▪ We also need to ensure that the data capture is accurate and in line with MINAP guidelines, we have put in an audit officer for PPCI within the business case to ensure the accuracy of data being used for this indicator April 2010 Michelle Rhodes Standard March 75% 63% YTD N/A Forecast A Expected date to meet standard September 2010 Lead Director Michelle Rhodes | 4
Escalation pages (4/4) Patient complaints responded to within agreed time Indicator level 1 Standard 90% % patient complaints responded to within agreed timescale March YTD Forecast 89% What is driving the reported underperformance? What actions have we taken to improve performance? ▪ Matrons and Clinical Leads have been ▪ During this period the Complaints Lead has provided addition supporting the increased operational support by reviewing and editing response letters for those activity during the winter months, directorates where timelines have been more difficult to achieve which has led to challenges in delivering timely responses Expected date to meet standard Lead Director % theatre usage over past month Indicator level Jenny Leggott Standard 80% Specialty Usage of Session Time What is driving the reported underperformance? ▪ Session utilisation (due to cancelled list) ▪ In session utilisation ▪ Theatre closure 1 June 2010 March 72% YTD 71% Forecast A What actions have we taken to improve performance? ▪ Productive elective specialty (Better for you) ▪ Performance management framework ▪ Cancellation fees Expected date to meet standard Incremental as Better for You rolls out Lead Director Michelle Rhodes | 5
The In-Depth Review: Cancelled ops % of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or on the day of operation Cancellations by Directorate % per directorate in Mar 10 Cancer and Thoracic and associated specialities digestive Diabetic, infection, diseases renal and cardiovascular Number of cancel Number of * Cancellations Trend Number per month Diagnostics and clinical support 38 102 65 Family health Musculoskeletal and neuro -sciences Head and neck Mar May Jul Sep Nov 2009 Reasons for Cancellations Number Complications Previous Patient Emergencies/Trauma Surgeon Unavailable Other Equipment Failure/Unavailable Medical/Anaesthetist/Theatre staff unavailable Replaced By Urgent Case Theatre Time Unavailable No ICU/HDU Beds List Overrun Ward Bed Unavailable Jan Mar 2010 Mar 10 Agreed corrective actions (planned Feb 10 Issues causing underperformance and commenced) ▪ Cancellations in March were due ▪ Revised processes and procedures largely due to lack of ward beds to be followed have been finalised available due to D&V virus City with directorates Campus (Lister ward) and at ▪ Weekly PLT meeting set up to look QMC (D 8), in addition to at reasons for cancellations Operating list over runs. ▪ Directorate level trajectories have Scheduling of Operating lists been set up being reviewed to ensure ▪ Performance management effective utilisation of lists by framework in place Directorates Indicator level Red Amber Green Latest YTD performance Forecast Signed off by: Expected date to meet standard: Plan for next Board report: 1 >1. 5% 0. 8% - <0. 8% 1. 53% Amber Michelle Rhodes 0. 8% in month for Dec 10 – Mar 11 July 2010 SOURCE: ORMIS, PAS, HISS, Information team 1. 6% | 6
The In-Depth Review: 18 week Number of treatment functions which are failing the 18 week admitted or non-admitted targets The number specialties with <85% of eligible admitted patients whose adjusted RTT clock stopped in 18 weeks or less (<127 days) or <90% of eligible nonadmitted patients whose RTT clock stopped in 18 weeks or less (<127 days) Month Standard Actual # Treated Breaches Admitted: Spines Admitted: Trauma and Ortho Admitted: Neurosurgery 203 51 90% 84. 0% 463 74 90% 79. 2% 48 10 90% 81. 0% 84 16 Non admitted: Neurosurgery Non admitted: Spines 95% 82. 6% 69 12 95% 91% 267 24 Non admitted: Trauma and Ortho Non admitted: Maxillo Facial 95% 94. 1% 236 14 95% 92. 6% 444 33 Agreed corrective actions (planned and commenced) Funding approved to open 6 beds Additional spinal theatre capacity Bed and theatre capacity Spines 74. 9% Admitted Maxillo Facial Issues causing underperformance 90% Trauma and Ward closure due to D&V virus Consultant sickness leave Ortho Patients moved out to the private sector Beds opened on a temporary basis to allow more electives admissions Review of administration services within the specialty Neurosurgery Bed and theatre capacity Imminent appointment of locum neurosurgeon. Use of private sector Additional capacity Maxillo Facial Reduction in day case procedures Cancer surgery has been extremely active in the first quarter All daycase beds now open Additional consultant capacity Indicator level Red Amber Green 1 1 N/A 0 Latest YTD performance Forecast Signed off by: Expected date to meet standard: Plan for next Board report: 3 Red Michelle Rhodes September 2010 July 2010 N/A | 7
The In-Depth Review: Sickness Rate per Directorate % Mar-10 Sickness Rate % Agreed corrective actions (planned and commenced) Issues causing underperformance • The Trust has made significant progress with reducing sickness absence, with an underlying downward trend. • Robust sickness management policy in place • Directorates continue to work towards the challenging Trust target of 3% sickness by March 2011 • Ongoing monitoring of all sickness absence Trust-wide Indicator level Red Amber Green 1 3. 5% 3 -3. 5% 3. 0% • Closer scrutiny on 2 areas reporting highest sickness • Further escalation methods being considered Latest YTD performance Forecast Signed off by: Expected date to meet standard: Plan for next Board report: 4. 09% Red Danny Mortimer March 2011 Monthly N/A | 8
Projected Improvement Trackers 62 days urgent referral to treatment of all cancers % of patients receiving first definitive treatment within 62 -days following referral from an NHS Cancer Screening Service during a given period Standard 85% Month escalated May 09 Performance when escalated 77. 9% Latest period 86. 7% YTD 80. 5% Lead Director Actions taken and lessons learnt ▪ ▪ ▪ Michelle Rhodes ▪ ▪ ▪ A&E 4 hour wait target % of patients spending four hours or less in all types of A&E department, until discharge/ admission/ transfer Standard 98% Month escalated Aug 09 Performance when escalated 97% Latest period 99% YTD Michelle Rhodes Actions taken and lessons learnt ▪ Implemented actions from national emergency care intensive support review ▪ Additional senior mangers support to patient flow process ▪ Additional clinical start in ED and admission wards ▪ Development programme for advance nurse practitioners ▪ Additional winter beds 97% Lead Director Specialties produce a Root Cause Analysis report to understand the cause of their breaches. This is presented at the weekly Cancer PTL meeting. There is Directorate Management representation at the Cancer PTL, with Directorates feeding back on patients. This has improved the lines of communication and accountability. A red alert system for cancer diagnostic referral requests has been implemented both at NUH and Treatment Centre with a maximum 5 days turnaround time for tests. The majority of Patient Navigators are now working within the specialty areas, which has improved clinical engagement as well as identifying where potential problems exist with the patient’s pathway. Patient pathways for each tumour site have been reviewed and bottle necks identified. The new pathway are currently being agreed and signed off by the Clinical Leads. A daily PTL has been developed with all 62 day patients from day 1 of entering the pathway. Specialties have received training on how to use and access this report. | 9
Appendix 1: NHS Performance Framework Indicators 2009/2010 2 Standards and targets: SOURCE: NHS Performance Framework Implementation Guidance (Annex 1: Operation Standards and targets indicators acute trusts - June 2009) | 10
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