The Special Delivery Unit (SDU) is planning to conduct a performance diagnostic analysis of the unscheduled care system in the acute hospital sector over the coming months. As part of the analysis, the SDU recently visited the Mid West Regional Hospital in Limerick. The SDU today (5th October 2011) published its 13 recommendations following this visit. Mr Tony O'Brien, Chief Operations Officer of the SDU said " All of these recommendations should be taken in their entirety as a pathway towards enhancing the quantum and quality of services provided to patients by the hospital. None of the recommendations should be taken in isolation nor should one be given prominence over another. They require constructive action from all parties involved in the provision of care in the hospital and should be taken as a complete package, designed to improve the patient care and experience."
Performance Diagnostic Recommendations from the Special Delivery Unit for the Mid Western Regional Hospital Limerick
1. The hospital and hospital group bed plans should be immediately reviewed with a view to reallocating some existing nursing and support staff resources to expand the flexibility of available medical bed days, and meet the demands of the surgical services that must remain at the Dooradoyle site.
2. The hospital should undertake a systematic capacity and demand analysis. The SDU has used the data provided to run a high-level preliminary capacity model and the early indication is that with some improvements to length of stay and some reorganisation of existing capacity, the system can be brought into balance, greatly improving the likelihood of reducing trolley waits.
3. Urgent consideration should be given to converting some daycase capacity to support the emergency medical flow if this is possible, by reallocating services to other hospitals in the group.
4. The resources must be identified and the professional agreements secured to move to the planned MAU as a matter of urgency, and from there to implement the remaining provisions of the Acute Medicine Programme.
5. Clinical risk assessment should be conducted where additional beds are being placed on inpatient wards to ensure space and facilities are adequate.
6. The admission profile and anticipated volume of scheduled care admissions and the hospital’s capacity to meet anticipated demand should be reviewed and a bed management system empowered to ensure variation in surgical demand is reduced. The clinical head of bed management must have devolved authority, responsibility and accountability for all the admission, transfer and discharge processes.
7. Intensive management support should be provided to the site as a support to on-site senior management. This management support should be provided by resources with specific leadership experience and a track record of successful hospital management, including performance improvement. This resource should be focused on supporting immediate performance improvement and the development of a programme to implement new performance management arrangements.
8. The hospital should consider developing an organisational development programme to address issues of professional leadership and improve relationships.
9. The process of implementing the escalation plan should be reviewed to ensure it operates in the correct sequence and the Full Capacity Protocol (FCP) is used only as the final step in this plan. The option of reopening closed capacity on a time-limited basis should be considered prior to placing additional beds in existing wards as part of the FCP. Strict adherence to the de-escalation and a review components of the FCP are also required.
10. The bed bureau system should be enabled across the hospital group.
11. A formal daily communication process should be established with the Ambulance Service.
12. The hospital should consider establishing a Patient Flow Response Team, (comprising Nursing, Consultant, Bed Manager), to manage all processes and expedite patient movements through the system on a daily basis.
13. The situation of medical leadership must be resolved, ideally leading to the prompt filling of the Executive Clinical Director post.