APPENDIX 5B
URGENT CARE PROGRAMME
PROGRAMME INITIATION DOCUMENT
1. BACKGROUND:
National & regional trends for urgent care admissions are rising; however in Warrington admissions remain 20% over the national average. This together with the projected increase in long-term conditions, dementia and frail elderly demand for unscheduled care is financially unsustainable and requires alternative solutions to hospital based care. Integration is essential to the development of effective urgent and emergency care services.
This Programme updates the Strategy for provision of Unscheduled Care in Warrington (2008) and carries forward recommendations from the following,
· ECIST Recommendations 2010
· Trauma and Injury Service Review (June 2011)
· Unplanned Care (Aug 2011)
· ECIST Draft Specification
2. PROGRAMME DEFINITION:
The programme aims to redesign urgent care service delivery in order to manage emergency care and reduce inappropriate hospital admissions more effectively. The programme aims to ensure a seamless service for the patient irrespective of which organisation is providing the care or how they enter the system.
3. PROGRAMME OBJECTIVES:
The overarching strategic goals underpinning this Urgent Care vision are to deliver services that are responsive to patient needs and achieve,
· Improvements in the system’s ability to address urgent of care needs
· Reduction in avoidable A&E attendances
· Reduction in both the number of episodes of, and the duration of emergency admissions.
4. PROGRAMME SCOPE:
In Scope
Services for Ambulatory Patients who do not require Hospital Admission Front Door Triage & Streaming
Ambulatory Urgent Care & Ambulatory Emergency Care (PAU, SAU & MAU)
Out of Scope
Adults & Children’s Services beyond Primary Care Front End
Appropriate A&E attendances based on presenting symptoms
Setting up the Ambulatory Rapid Response Services
5. PROGRAMME DELIVERABLES:
The components of the Ambulatory Care Department Front End of A&E department’ will include an:
· Ambulatory Urgent Care Unit: An experienced Senior Clinician will stream and triage patients deemed “Ambulatory” into this unit from the front door providing rapid initial assessment in order to increase the proportion of patients that are treated and discharged without requiring an A&E attendance and/or an emergency admission.
· Ambulatory Emergency Care Unit is the door to Emergency Care within the Hospital for patients under an acute medical, surgical or paediatric specialist requiring on-going clinical supervision.
· Ambulatory Diagnostics, Imaging & Pathology Protocols which will facilitate assessment and treatment of Patients to managing the care of LTC patients and their carers.
6. Relationship with or Dependency on Other Programmes:
There is a relationship to the following programmes however the Urgent Care Programme is focused on improving the system’s ability to address urgent care needs, reduce avoidable A&E attendances and reduce the number of emergency admissions,
· Long Term Conditions
· Frail Elderly
· Mental Health
· Childrens Programmes
· End of Life
The Urgent Care Programme has a key dependency with the Information Programme, and will brief the programme on its information requirements.
7. Assumptions
The programme is part of the Integrated Quality Innovation Productivity & Prevention (QIPP) programme. There is an assumption that this programme will integrate service delivery in order to make better use of limited resources, address rising demand and ensure equitable and high quality service provision.
Service improvements will be evidence based and address quality, innovation productivity and/ or prevention. Quality improvements and cost savings are fundamental to the programme & service improvements will need to demonstrate how they deliver these.
8. PROGRAMME APPROACH:
8.1 Delivery Structure Ambulatory Care Department
Figure 1: Work streams and Sub Groups for Ambulatory Urgent Care Unit
The Ambulatory Urgent Care Unit Project comprises of three Core Workstreams:
· Ambulatory Urgent Care Work stream
· Diagnostic Pathways and Protocols Work stream
· Ambulatory Emergency Care Work stream
The remit of these Work streams are to:
· Define the schedule of accommodation requirements, IT needs to successfully deliver the front end model
· Clarify roles and responsibilities and remits of staff within the facility
· Agree Clinical strategy within each Unit
· Agree Ambulatory Care Streaming Criteria from the Front door
· Agree Ambulatory Care Sensitive Pathways within the Unit
· Agree Operational Policy within the Department
· Identify, design and implement Protocol driven Diagnostic Pathways for use by the Ambulatory Urgent Care Unit to request diagnostics
The deliverables within these Work stream collectively are:
· An agreed Clinical Strategy
· Workforce Compliment and Competencies
· Ambulatory Front End Schedule of Accommodation
· A shared Operational Policy
· Information Technology Policy
· Diagnostic Protocols
Figure 2: Support & Enabling Workstreams
The support & enabling workstreams will:
Ø address IT issues and requirements for the Ambulatory Care Department in terms of how IT can facilitate, streaming from the Front Door, Communication both internal and external to the Unit especially pertaining to discharge information and Performance Monitoring
Ø focus on developing service quality and performance metrics, for the Ambulatory Care service to:
· Enable quality to be measured and for the service to be progressively improved
· facilitate meaningful commissioning
· enable providers to understand their activity
· define realistic and meaningful clinical outcome measures in each clinical area
· explore innovative ways of improving the quality of clinical data collection.
· determine the systems and staffing necessary to collect the required data in a reliable manner
Ø Provide analytical and modelling support
Ø Ensure a safe staffing compliment in terms of competencies and numbers for the composite units in the department
Communications and Stakeholder Engagement support workstream
The intention is to work closely with the 3rd Sector Hub which has an independent Chair who will guide the group in successful engagement of the public, and inform service users, the general public and other stakeholders about the implementation and implications of the Ambulatory Model. The Chair sits on the Ambulatory Care Delivery Steering Group. It will be the representative body for all key external stakeholders and will drive effective two-way communications about the project. It will facilitate feedback and, where necessary, promote constructive local debate in order for the Patients and Public to shape service redesign
The main functional responsibilities of this support workstream are to:
Ø encourage an atmosphere of trust, openness and communication and an attitude based on working together and shared objectives with Patients and the Public
Ø proactively look for ways to improve the relationship between Providers and Patients and the Public wherever possible
Ø ensure that Patients and the Public feel that they are involved, that their views are important and that they are acted upon
Ø establish and manage a communication framework and ensure that it is used effectively
Ø establish and manage communication flows between patient and provider, and ensure that they are used
Ø ensure that communications at all levels are peer-to-peer
Ø resolve 'soft' tensions between patients and provider, that is, situations where tension is felt or perceived but no formal issue has yet arisen
8.2 Ambulatory Emergency Care Unit
The Ambulatory Emergency Care Unit is the door to Emergency Care within the Hospital for patients under an acute medical, surgical or paediatric specialist requiring on-going clinical supervision. The Ambulatory Emergency Care Unit involves the Assessment Medical Unit (AMU), Surgical Assessment Unit (SAU) and Paediatric Assessment Unit (PAU). The project is being led by Warrington and Halton Hospitals NHS Foundation Trust and is a key component of the Urgent Care Programme.
9. Key Performance Indicators & Benefits
Key Performance Indicators (KPIs)
The key performance indicators (KPIs)will provide the most important performance information that enables us to understand whether the programme is on track. The programme will determine KPIs that will demonstrate what success looks like and these will be SMART ( Specific, Measurable, Achievable, Realistic and Timely).
Benefits
Benefits Management aims to make sure that the desired changes have been clearly defined, are measurable, and provide a compelling case for the change and ultimately to ensure that the outcomes are actually achieved. The programme will define its intended benefits/ dis-benefits of the change & remain focused on delivering these to ensure the programme delivers value and remain aligned with the overall objectives of the programme.
The development of the benefits criteria will be undertaken with our users and carers. They will be engaged in determining what the success criteria for the programme is, building on the benefits articulated by partners engaged in the Stakeholder Planning Workshops. Benefits that have been identified to date include:
Programme Plan:
See attached Programme Plan
Risk Log:
See attached Risk Register
The Risk Register contains some early risks that the delivery group identified. These will be analysed and the register developed as a key deliverable of an initial delivery group meeting.
Project Organisation Structure:
See attached Project Organisation Structure
Communication Plan:
The Communication plan will follow, however attached is the first draft of a stakeholder impact assessment from the delivery group.
Programme Manager:
Date:
Approved by: (Executive)
Date approved:
Document No.: Urgent Care Programme PID /2012 06 19 /V2