For many patients the gateway to care is the Emergency Department (ED). Patient arrival activity is complex: case mix, staffing groups and contracts, attendance patterns, department size and layout, admission profile, bed availability, social care provision, interaction with and availability of services such as frailty, SDEC/combined assessment and treatment, and mental health provision are just some of the factors that need to be considered when producing a plan. Through interviews with lead clinicians we build models of clinical pathways and use data analysis to predict future patient demand. The resulting simulations analyse ED performance and sensitivity to fluctuations. Our recommendations are made in terms of number and type of clinician and organisation of their working patterns in terms of rotas and rosters.
In the last 3 years we have conducted more than 35 ED reviews for NHS clients.
Appropriate staffing on wards is vitally important for patients' safety and efficient patient flow. The RCP report on safe medical staffing highlighted the fact that appropriate levels of staffing are associated with reduced patient mortality and length of stay (LoS). For surgical specialities, it is vital that the surgical workforce is the right size for case load and case mix.
If wards are not staffed appropriately then the benefits of an efficient ED and admissions process are lost as the upstream effects of longer LoS and delayed transfers of care (DTOC) from wards cancel out these benefits. For medical and surgical specialities, the KBC process includes pathway and patient demand analysis, calculation of required WTEs and build of operational solutions (rotas & rosters).
We use our team of clinical workforce experts to ensure that when recommendations are made regarding rota design and skill-mix solutions, full account is taken of all employment contract specifications. In addition, by optimising the deployment of existing staff (through efficient rota and roster design) we can often reduce or eliminate the need for additional posts. We will also consider skill mix and additional roles to identify innovative and different ways of working where workforce shortages may exist.
Patient pathways extend beyond the hospital into social care. The efficiency of patient transfer from secondary care to social care depends critically on sufficient capacity in these next-step care settings. The impact of delays in this transfer of care is significant, with 1.68 million bed days lost in 2019 in England. However, it is possible to predict and model the arrival of patients and the required capacity to deal with these patients. Our social care requirements simulator builds on this work and models the pathways that contribute to the highest number of patients requiring next-step social care (e.g., stroke, fractured NOF, mental health, frailty). The outputs of the model can then be used to assess the level of different social care requirements over a period of time, when they will be required and by which local authority. In addition, our model provides an early warning system for Trusts and discharge hubs of the likely social care needs of a patient when they arrive at the front door. This information is vital in helping prepare more effectively for the transfer of care and in eliminating avoidable lost bed days.
For health boards in Wales, we provide assurance services around the resourcing of D2RA pathways and modelling for right-sizing community services.
Historically RTT performance has been measured as the proportion of elective patients treated within 18 weeks. The target being 95%. In the wake of the Covid-19 and a concomitant rise in the elective backlog, the government has set new RTT performance targets. It is difficult to assess whether your PTL will meet these new targets and what levels of service activity or bought in activity you will need to meet these future targets.
Our Elective Recovery Service runs multiple "what if scenarios" for patient demand and activity to assess how your PTL will look in the future. Our models show the movements of your PTL on a day to day basis.