Balanced Score Card Report Review of January 2019 Data

Balanced Scorecard

Patient Access

Quality

&

Safety

Human Resource

Management Finance

Patient and Service User

Patient Access – Emergency Department

Mean PET & 8AM TrolleyGAR per 100 ED Attends

CUH 30 Day Moving Average 2018 v 2019

ED Presentation January Comparison

0

1,000

2,000

3,000

4,000

5,000

6,000

2015 2016 2017 2018 2019

4,768 5,127 4,818

5,456 5,949

ED Attendances & Admissions: Month & YTD

Ages: All

ADMITTED from ED (Ages: All)

2019 2018

Hospital Group Hospital January YTD January YTD January YTD

South/South West Hospital Group CUH 1,815 1,815 1,730 1,730 4.9% 4.9% Kerry 956 956 948 948 0.8% 0.8% Mercy 605 605 633 633 -4.4% -4.4% South Tipp. 963 963 778 778 23.8% 23.8% Waterford 1,311 1,311 1,116 1,116 17.5% 17.5%

South/South West Hospital Group 5,650 5,650 5,205 5,205 8.5% 8.5%

ED Attendances & Admissions: Month & YTD

Ages: 75+

PET >24 Hours January 2019

Bed Day Occupancy >14 Days (30 DMA)

>100 Day Occupancy 30DMA

Project Flow Improving Patient’s Hospital Experience

Project Flow 2018 - Five Fundamentals

Pre Admission

• Acute Floor

• ED

Ambulatory

/ Paeds

Area

Redesign

• 24/7 AMAU

• D2A

• Non

Admitted

PET

• Citywide

Ambulatory

Care

Pathways

Post

Admission

• SAFER

• Maximising

community

services (inc

CIT, ICT,

OPAT,

CREST)

• Weekend

D/C

• Red 2

Green

• Over 14

days/

Egress

Themes

• SDU

Delayed

Discharge

Recommen

dations

• Admitted

PET

Cross

Cutting

• Over 75’s (inc

FIT)

• Diagnostics

• Older person’s

– group wide

• SAFER - group

wide

• FIT – group

wide

• Community

specific

including:

1. Bed bureau

2. Single referral

form for

community

services

3. IPMS

4. Performance

metrics

Proposed Next Steps

Develop a communication strategy for the project

Hold a mini workshop (CUH and CKCH) to review the scope of all current projects to determine: • What does good look like? • What benefits are current projects delivering? • Can projects be prioritised? • Are optimal project metrics being used to track

improvements?

Develop an implementation plan for a change programme for the next 6 months with targets for all projects (in line with national programmes)

Engage with the staff on the ground

Local USC governance group to act as project steering board as per TOR

CUH/CKCH Five Fundamental Project

Christmas Plan - Additional Measures

24/7 AMAU Service from 27th December

Additional Emergency Medicine Paediatric Medicine and Acute Medicine Registrar

Curtailment of scheduled activity 24th Dec – 7th Jan

15 beds purchased in the Mater Private

Inpatient diagnostics prioritised 27th December – 11th January

GA 5 Day – 7 days month of January

Falls Intervention Team

Series of Daily Operational Meetings

Additional Assistant Director of Nursing at weekends

AMAU Activity January 2019

AMAU Referrals from ED

0

5

10

15

20

25

Total AMAU Admissions

0

50

100

150

200

250

300

Surge ED ED Gp Referral Planned RepeatAdmission

Other Referral Source

43

256

123

65

16

Total AMAU Admissions

Diagnostic Waiting List

Average Diagnostic Waiting List January 2019 57

32

45

0

10

20

30

40

50

60

CT MRI ECHO

Ave

rage

nu

mb

er o

f p

atie

nts

wai

tin

g Ja

n

2019

Patients waiting transfer to SFH & SIVUH January ‘19 Daily waiting SFH & SIVUH

Average Waiting SFH & SIVUH

12

4

0

2

4

6

8

10

12

14

SFH SIVUH

Nu

mb

er

of

pat

ien

ts

Patient Access - Outpatient Waiting Lists

Time to Put a Referral on iPMS by Central Appointments

19

0.78

0.66 0.75

0.59 0.76 0.64 0.77

0.54 0.70 0.83

0.68 0.73

0.79

0

1

2

3

4

5

6

7

Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18

Average Days to Put New Referral on iPMS

Average Time to Put on iPMS

Triage Turnaround Time

20

3.24

2.37

2.67

2.14

2.93

3.38

2.89

3.41

2.36

3.94

3.41

2.74 2.68

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18

Average Working Days to Complete Triage for Central Appointments

Total Medical Patients to be seen by 15 Month Target

(December) (379)

300

19 18 16 10 6 3 2 2 1 1 1 0

50

100

150

200

250

300

350

Total Surgical Patients to be seen by 15 Month Target

(December) (4095)

744

701

545

495

368 360

215 184 178

93 72 64

49 14 5 3 2 2 1

0

100

200

300

400

500

600

700

800

Total Paediatric Patients to be seen by 15 Month Target

(December) (110)

23

46

27

21

15

1

0

5

10

15

20

25

30

35

40

45

50

Paediatric Neurology - OliviaO'Mahony

Paediatric Neurology - NiamhMcSweeney

Paediatrics - Louise Gibson Paed Endocrinology - DanielColm Costigan

Paed Endocrinology - StephenO'Riordan

Patients Currently Waiting Longer Than 12 Months (December) (5666)

3618

887

397

130 127 107 96 83 66 37 26 23 20 17 16 12 4 0

500

1000

1500

2000

2500

3000

3500

4000

Patients to be seen by 15 Month Target )

276

1099 967

731

1410

100 1 0

200400600800

1000120014001600

12-15Months

15-18Months

18-21Months

21-24Months

24-36Months

36-48Months

48+Months

4584 Urgent and Routine Patients who need to be seen in relation to the 15 month deadline by month end of December 2018

Count of Patients %

No of Patients with an Appointment before or on End of Month 51 1.11%

Number of Patients with an Appointment Post End of Month 130 2.84%

Number of Patients with No Appointment 4403 96.05%

Patient Access - Inpatient Waiting List

Total Inpatient & Day case Waiting List (13/02/2019)

wl type ACTIVE PREADMIT SUSPENSION Grand Total

Adult 1201 392 46 1639

Child 137 46 1 184

GI Scope 103 206 4 313

Grand Total 1441 644 51 2136

Prospective Adult Pivot - to be Treated by December 2019

(as of 13/02/2019)

Rescheduling of Appointments post INMO Industrial Action

Quality & Safety

Risk Management - January KPI data

Serious Reportable Events – 3 communicated in January

Medication Safety Incidents reported - 54

Complaints –8 with 12.5% closed within the 30 day timeframe

New claims notified to hospital - 3

Risk Register

No new risks added

Scope Waiting List (February 2019)

Cancer KPI – Breast-Lung-Prostate July – December 2018 & January 2019

Radiation Oncology KPI – January 2019

IN TARGET, 71, 89%

OUT OF TARGET, 9, 11%

Patients In/Out of Target January 2019

Total Patients 80

Reasons for Delay - January 2019

0

1

2

3

4

5

6

Personalchoice

Medical Capacity DataMissing

Other

Total 1 6 1 0 1

Medical Oncology KPI – January 2019

In Target, 54, 95%

Outside Target, 3, 5%

Patients In/Out of Target January 2019

Total Patients 57

Reasons for Delay - January 2019

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

Personal MedicialTotal 2 1

CPE - Current Status

Currently two patients confirmed with CPE

CPE Working Group has been reconvened

The CPE Working Group will oversee the implementation of the recommendations in the report issued by HIQA.

Flu Pandemic

24 confirmed cases 38

Human Resource Management

Total Sick Leave

4.77

3.84

3.924.22 4.17 3.9 3.65 3.98

3.89

3.84

4.154.35

4.42 3.8

4.013.8 4.02 3.84 3.54 3.82

4.724.32

4.56

3.5 3.53.5

3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5

0

2

4

6

Jan Feb Mar April May June July August Sept Oct Nov Dec

%

CUH – Total % Sick Leave 2017 v 2018

2017% 2018% % Target

29.2

26.829.83

26.11

31

24.1

32.62

40.09

37.62

29.39

28.89

33.23 33.99

42.01

0

10

20

30

40

50

Oct-1

7

No

v-17

De

c-17

Jan

-18

Feb

-18

Mar-1

8

Ap

r-18

May

-18

Jun

-18

Jul-1

8

Au

g-18

Sep

-18

Oct-1

8

No

v-18

WTE’s

CUH Long Term Sick Leave – WTE’s

EWTD Compliance June – December 2018 & January 2019

Finance

Draft Cost Containment Plan 2019 Actual 2018

€k Savings

target €k Basis Pay: Medical overtime 11,044 552 5% target reduction

Nursing agency-conversion 2,766 277 10% saving

HCA agency- CAMHS 300 300 Charge to CH04

HCA agency-conversion 3,289 329 10% saving

Other overtime 981 98 10% saving

Misc-Time related savings 300 Delay in filling posts

Non-pay : 2,064 700 (1H18 €1.4m; 2H18 €0.7m) Managed service

Procurement 250 New contract prices

Medicines excl PCRS 22,278 500 Biosimilars

PCRS Budget uplift 600

Blood 5,565 278 5% reduction

Non-DLU 795 200 25% reduction

Energy 2,889 144 5% reduction

Storage 882 114 Doughcloyne rent Lab external tests 1,396 70 5% reduction

Staff recruitment/training 1,074 54 5% reduction

Computer 947 36 ILAB support Other 82,227 300 Reduced activity year-end Add funding-demographics, equipment replacement etc 500

Total 5,602

Capital Projects

Capital Projects Project Status

Paediatric Unit Phase 1 - build programme completed

Phase 2 – funding received – proceed to Design Stage

Radiation Oncology Unit

Building Handover scheduled for 25th March 2019

Education and Training Centre Draft Statement of Need completed and discussion ongoing

with UCC

Meeting held with UCC

Blood Sciences Project

Design Team appointed

Infrastructural works are near completion

Oncology Service

Expansion of Day Unit – plan signed off

Refurbishment of Ward 2D – capital funding in place

Medical Oncology Centre – developing Statement of

Need

Mammography Units replacement programme

completed

Ophthalmology Transfer – Phase 2

• OPD & Day Care – Tender documents ready to issue in

January ‘18

• Theatre Accommodation tender documents being

prepared for early ’18

Helipad

Approval received from the IAA

Planning queries being addressed