NHS Dumfries and Galloway & Partners CAPACITY MANAGEMENT PROCEDURE Indicators DUMFRIES AND CAPACITY MANAGEMENT PROCEDURE – STATUS Early warnings of pressure in one or more parts of the system and need to manage pressure out of the system ED and INPATIENT (Acute) PRIMARY AND COMMUNITY CARE DIRECTORATES SCOTTISH AMBULANCE SERVICE (SAS) SOCIAL WORK SERVICES Indicators Indicators Indicators Indicators Reduction in capacity to meet elective and emergency admissions i.e. Challenge to meet ED 4 hours target All electives allocated a bed Staffing levels pressure to deliver workload ITU/HDU beds available Emergency theatre available No significant problems reported with clinical support services (theatres, pathology, pharmacy, supplies/equipment etc.) Pressure on available capacity to meet elective and emergency admissions Staffing levels under pressure to deliver workload Pressure on available capacity to accommodate additional notice transport requests Staffing levels under pressure to meet additional demand Pressure on beds across the care home sector Staffing levels under pressure to meet demand Staffing levels-vacancy factor, inability to recruit to key posts Domiciliary care-reduced availability of service from the independent sector/in-house sector Equipment -reduced availability and in supply and fitting Pressure to meet deadlines as per Admission, Discharge & Transfer procedure All patients funded by Local Authority discharged by 48 hours
Intervention DUMFRIES AND CAPACITY MANAGEMENT PROCEDURE – GREEN STATUS warnings of pressure in one or more parts of the system and need to manage pressure out of the system ED and INPATIENT PRIMARY AND COMMUNITY CARE DIRECTORATES SCOTTISH AMBULANCE SERVICE (SAS) SOCIAL WORK SERVICES Intervention Intervention Intervention Intervention
ED and INPATIENT PRIMARY AND COMMUNITY CARE DIRECTORATES SCOTTISH AMBULANCE SERVICE (SAS) SOCIAL WORK SERVICES Indicators Indicators Indicators Indicators Number of elective/emergency admission is causing significant pressure on available bed capacity Considerable pressure on staffing levels to provide safe and appropriate care i.e. Delays in beds available in Ward 7 Patients in ED waiting > 4 hours for transfer to wards Impacting on elective admissions ED department breaching 4 hour target Adult ITU/HDU beds under pressure Emergency theatre available Intermediate problems reported with clinical support services (Theatres, Pathology, Pharmacy, Supplies etc) Any incident that significantly affects patient flow Infection control concerns that may impact on bed availability (see relevant infection control policy) Increasing pressure on bed capacity within community bed setting Considerable pressure on staffing levels to provide safe and appropriate care Infection control concerns Any incident that significantly affects admission or discharge No capacity to accommodate transport requests at short notice for outpatient appointments Bed availability – reduction in beds available across the care home sector Staffing levels-vacancy factor unable to recruit to key posts Domiciliary care- no availability of service from the independent sector/in-house Equipment- waiting lists and delay in supply and fitting Pressure to meet deadlines as per Admission, Discharge & Transfer procedure Intervention DUMFRIES AND CAPACITY MANAGEMENT PROCEDURE – AMBER STATUS Escalating pressure in one or more parts of the system and need for affirmative action across the system to manage capacity and demand
ED and INPATIENT (Acute) PRIMARY AND COMMUNITY CARE DIRECTORATES SCOTTISH AMBULANCE SERVICE (SAS) SOCIAL WORK SERVICES Intervention Intervention Intervention Intervention All Green Status Interventions completed Additional consultant ward rounds will be initiated in all wards Nurse in Charge to inform Capacity Manager / Site Manager or Duty Manager Consultant presence required on ward 7 and in ED DGRI and medical presence in GCH Capacity Manager / Duty Manager inform Cascade List and initiate following actions:- Discharge awaiting investigation identified in Green Inform Community Care, NHS 24, Out of Hours Service and SAS of amber status Establish as early as possible staffing potential for Opening all closed beds including Day Surgery Unit for overnight care. Where appropriate identify low clinical patients and transfer out to cottage hospitals. Consider based on intelligence informing communications team to prepare press/media statement Consider based on intelligence and with medical support cancelling all elective activity (excluding angiograms) within Medicine Consider on intelligence and with medical support identifying and cancelling non-urgent elective surgery (including specialist services, orthopaedics, gynaecology and medical angiograms) activity in discussion with the clinical director/manager Actions to be taken before moving to Red Capacity Manager / Site Manager or Duty Manager inform Cascade List and initiate following actions:- All surgical specialties to identify and prioritise urgent surgical patients for potential cancellation All Green Status Interventions completed Nurse in Charge to inform Cottage Hospital Service Manager of current status, Community Service Manager to inform Capacity Manager / Site Manager or Duty Manager, Cancel all elective admissions GP ward rounds within Community hospitals to identify and facilitate discharges Maximise ALL resources available in Community, i.e. Intermediate care District Nursing Services Community rehabilitation teams CPN teams Full use of infection control team All Interventions made No short notice requests for ambulance transport to be accepted All Green Interventions made Inform all other agencies of situation Consider delaying all non-critical respite admissions to care homes Contact all relevant agencies to assist
AMBULANCE SERVICE (SAS) Indicators Indicators Indicators Indicators All Amber interventions completed across all sectors Unlikely to return to Amber status within next 4 hours All bed capacity fully utilised across all sectors ITU/HDU beds under significant pressure (see ITU/HDU escalation policy) Emergency theatre limited capacity/unavailable Shortage of equipment / supplies in key areas Significant problems reported with clinical support services (Theatres, Pathology, Pharmacy etc) Any incidents that significantly affect patient flow Infection control concerns significantly impacting on bed availability (see relevant infection control policy) Inability to accommodate additional transport requests Bed availability – no beds available across the care home sector/ local authority or out of area Staffing levels- inability to recruit to key posts Sickness absence- significant staff in key posts unavailable to work Domiciliary care- fully maximised resource no service available from the independent service Equipment –no availability to supply and fit Intervention and Accountability DUMFRIES AND CAPACITY MANAGEMENT PROCEDURE – RED STATUS Demand outstrips capacity contingency plan arrangements ED and INPATIENT (Acute) PRIMARY AND COMMUNITY CARE DIRECTORATES SCOTTISH SOCIAL WORK SERVICES
AMBULANCE SERVICE (SAS) Intervention & Accountability Intervention & Accountability Intervention & Accountability Intervention & Accountability All Amber interventions completed. The Capacity Manager / Site Manager or Duty General Manager will contact Executive on call, who will trigger contingency planning team meeting. Contingency planning team convened within ONE hour in DGRI Received status report from Capacity Manager / Site Manager or Duty General Manager Inform all agencies of alert status Identify private sector capacity for transfer delayed discharged patients Utilise all available transport (e.g.) Local Authority provision Medical Director to lead on prioritising patients for:- Discharge from all specialties including all electives admitted that day Cancellation of prioritised urgent surgical list Cancellation of elective admissions for the following day Medical Director will discuss with on Call Consultants the temporary use of stay ward capacity Redeployment of theatre/recovery staff Release statement to press/media Capacity must be maintained in ED at all times to receive trolley bound emergency patients interventions completed Request assistance from Social Work department Cancel transport for non-essential outpatients.(contact clinics with details and clinics to contact patients Request staff to work overtime All interventions completed Establish bed availability out of area Senior management to identify resources available for purchasing additional beds Centralized control over deployment of available home care resources in both in-house and independent sectors Contingency Planning Team