Agenda item

To receive an update on the progress made in relation to patient handover performance since the presentation to the Commission at its last meeting.

To receive an update on the progress made in relation to patient handover performance since the presentation to the Commission at its last meeting.

Adrian Healy (EMAS) and Samantha Leake (UHL) gave a presentation on the current handover performance and the improvements and actions that had been made to improve the performance.  During the presentations the following comments and statements were noted:-

a)         The average attendance at the A&E unit was 500 patients per day and approximately a fifth were admitted to the hospital’s 830 beds.

b)         At high levels of attendance in the unit, patients could be treated in the triage cubicles if necessary and if all areas were full patients would be treated and monitored in ambulances.  Patients in need of high levels of care would be escalated through the system as safety of care and treatment was always paramount.

c)         There were currently less than 3% delayed discharges from the hospital, which had improved the ability to process admissions.

d)         The Unipart Process study had streamlined some parts of the system and had already produced reductions in ambulance waiting times and handovers, reductions in lost hours and improvements in EMAS response achievements and reductions in Assessment Bay demands.

e)         EMAS conveyed approximately one third of patients to hospital and this was normally around 160 patients a day to the A&E unit.  This had recently risen to 170 a day and over the Christmas period had been as high as 200 per day.

f)          The non-conveyance rate of patients in Leicestershire by EMAS was the highest in the EMAS regional area and was currently around 49%.

g)         A review of admissions to the A&E unit indicated that approximately 2% could have been re-directed/treated elsewhere, which was considered to be a relatively marginal amount.  This reinforced the view that the systems in place to give advice to patients was felt to be robust and effective.

h)        The impact of pressures of high admissions from falls, breathing difficulties and cardio-vascular issues normally encountered in the winter months had not been experienced during the current winter period.

i)          The rate of triaging patients within 15 minutes of attendance at the A&E unit had increased for the 20% when the Care Quality Commission had visited the unit in November to approximately 82% in recent weeks.

j)          The LRI had looked specifically at improving the flow of patients through the system and more patients were now being treated, where it was safe and appropriate, in clinical rooms by a nurse and health care assistant.  At periods of high volume demand this could be increased to four nurses and four health care assistants, to help improve the flows further.

k)         It was intended to provide an additional member of staff from February to provide patient care which would release ambulance crews from these duties at times of high attendance and enable them to return to active duty. 

l)          There were currently 130 nurse vacancies in the A&E and Specialist Medicine Division within the hospital.  There were 7 divisions in the hospital in total.

m)        Nationally there were 2,500 to 3,000 paramedic vacancies and EMAS were looking at ways to enhance service provision by using ‘technicians’ wherever possible.

n)        EMAS had procedures in place to identify patients who were high volume users of the ambulance service and a multi-disciplinary team was available to provide assistance in addressing any underlying issues.  The number of high users was not considered to have a significant impact on the service.

It was noted that Healthwatch had attended the A&E unit on a number of occasions since the beginning of the New Year to seek assurances that the measures introduced after the CQC inspection were addressing the clinical safety issues for patients that had been raised. Healthwatch were satisfied with the assurances that had been given.

AGREED:

1)         That the representatives of EMAS and UHL be thanked for their presentation and the steps that had been introduced to improve the performance of patient handovers be noted and be kept and review by the Commission.

2)         That the Commission be informed of reductions in performance for the handover process as it occurs rather than being informed 2-3 months afterwards.

3)         That the measures introduced to improvement performance be welcomed and that the efforts of staff to achieve this be recognised.

4)         The Commission recognised the need to treat patients in corridors at periods of high volumes of admissions but indicated it would not wish to see this practice continued when the new Emergency Floor was completed.