SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

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Exclusion criterion Complex fractures Patients receiving oncological therapy Sickle cell crisis Shortness of Breath Adults with signs of severe or life threatening asthma Airway compromise Acute exacerbation of Heart Failure Burns New CVA Significant DVT Haematemesis / Haemoptysis Overdose / Intoxicated and not able to mobilise Significant head injuries Additional information For example (but not limited to): Long bone fracture of legs Open fractures Spinal injury Patients receiving oncological therapy should be transferred to a hospital with an Acute Oncology Service. All Major Acute Hospitals have Acute Oncology services. "Severe" shortness of breath compared to normal Cyanosis Increased peripheral oedema Impaired consciousness or acute confusion Rapid rate of onset Associated with tachycardia > 110 beats per minute Inability to speak in sentences Shortness of breath associated with chest pain Shortness of breath associated with pallor and cold sweats Respiratory rate greater than 25 per minute Oxygen saturation < 95% in a previously healthy individual [E:e] History of severe asthma or recent emergency admission or a single ITU admission. Shortness of breath associated with chest trauma. cannot complete sentences pulse 110 beats per minute respiration 25 breaths a minute peak flow 50% predicted or best silent chest cyanosis bradycardia (heart rate < 40 bpm) exhaustion stridor quinsy oedema of tongue unable to swallow saliva/ drooling >5% Facial/ eye involvement Inhalation injury Chemical/ electrical involvement Patients with suspected DVT associated with chest pain/SOB or HR > 110 Are experiencing acute alcohol withdrawal or delirium tremens Are a danger to themselves or others Acute mental health presentation compromised by alcohol/drugs Unaccompanied by other responsible adult and need a period of observation Have taken any drug overdose Clinical concerns about a Cervical Spine injury: o Neck pain or midline boney tenderness o Focal neurological deficit 7b. Work of the Emergency and Urgent Care CIG 154
Exclusion criterion Mental health Additional information o Paraesthesia in the extremities o Any other clinical suspicion of cervical spine injury Head injury associated with GCS < 13 at presentation GCS < 15 when assessed 2 hours after the injury History of significant Loss of Consciousness More than one episode of vomiting Persistent headache Suspected open or depressed skull fracture Sign of basal skull fracture o haemotympanum, „panda‟ eyes, cerebrospinal fluid otorrhoea, Battle‟s sign Post traumatic seizure Focal neurological deficit Significant amnesia Dangerous Mechanism of injury pedestrian/cyclist stuck by a car, ejection from vehicle, fall from over 1 meter or 5 stairs Overdose Other significant self harm (adults). NB. Mental Health Trust advice is that this criterion should be open-ended and subject to clinical judgment. For example, a „simple laceration‟ would be inscope for the UCC. Any self harm (children) Severe withdrawal, delirium tremens and withdrawal seizures (as these are very likely to require medical admission) Acute psychosis with disturbed behaviour. Acute confused state/ delirium Require a secure environment (ie the main Emergency Dept) for assessment including suicide risk using current screening tool In addition to the exclusion criteria set out above, the following exclusion criteria will apply to paediatric patients: Figure 7.34 UCC clinical exclusion criteria (children) Exclusion criterion Acutely ill children Children with signs of severe or life threatening asthma Paediatric head injury Additional information All children identified as „acutely ill‟ using Paediatric Early Warning System (PEWS) too breathless to talk or feed respiration 40 breaths a minute in children over 5 years or > 50 breaths per min 5 minutes Abnormal drowsiness 2 or more discrete episodes of vomiting Clinical suspicion of non-accidental injury Post-traumatic seizure Use AVPU to assess level of alertness. Suspicion of skull injury or tense fontanelle Any sign of basal skull fracture o haemotympanum, „panda‟ eyes, cerebrospinal fluid 7b. Work of the Emergency and Urgent Care CIG 155
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North West London Shaping a healthi
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Table of contents Volume 1 Foreword
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Foreword Dr Mark Spencer The Clinic
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6. Consultation, feedback and how w
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13. Equalities implications This ch
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1. Executive Summary Introduction t
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The overall programme timeline is b
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The process was used before consult
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• Delivery of multi-disciplinary
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Stage 1 - Case for Change Our work
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For Quality of care, clinicians hav
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1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
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Assuring the proposals Throughout t
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Programme implementation arrangemen
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5. To agree that Hammersmith Hospit
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DMBC Chapter 2 - Introduction to th
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2. Introduction to the NHS in NW Lo
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Figure 2.3: Clinical Commissioning
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West Middlesex University Hospital
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major hospital, elective centre and
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DMBC Chapter 3 - Introduction to th
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3. Introduction to the Shaping a he
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3.3 Programme governance The Joint
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The JCPCT is advised by a Programme
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Consultation - during this phase, t
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Ensure consistency of communication
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Stakeholder Group Political Individ
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o o o o o Rationale for options dev
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The implications of the options in
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DMBC Chapter 4 -The Case for Change
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4. The Case for Change This chapter
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Stroke Services: The provision of s
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We need to do more to support patie
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In NW London, however, the NHS is s
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Figure 4.6: Emergency general surgi
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attack or stroke to designated cent
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Figure 4.9: Evaluation of primary c
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Inequalities would continue and pro
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DMBC Chapter 5 - Process for identi
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5. Process for identifying a recomm
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Figure 5.1: Basis of decision of wh
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We confirmed this decision, and the
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5.5 A detailed description of the s
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Correct care setting to deliver hig
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Figure 5.11: Ratings used in evalua
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DMBC Chapter 6 - Consultation, feed
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6. Consultation, feedback and how w
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6.2.1 Key findings from the consult
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times (particularly for patients tr
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Westminster City Council, Adult Ser
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Analysed and considered consultatio
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6.3 Our responses to feedback This
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Feedback received Stakeholders who
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6.3.3 Theme 3: Clinical vision and
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6.3.5 Theme 5: Proposals for local
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DMBC Chapter 7 - Clinical vision, s
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7a. Clinical, vision, standards and
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Local clinicians agreed that in ord
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▪ Expectant mothers should have t
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# Standard care services (111). As
Page 133 and 134: Figure 7.8: Development of the acut
Page 135 and 136: # Standard Adapted from source depa
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Page 139 and 140: No. Standard Adapted from source Su
Page 141 and 142: No. Standard Adapted from source se
Page 143 and 144: # Standard All emergency department
Page 145 and 146: # Standard All non-urgent - within
Page 147 and 148: Figure 7.18: Shaping a healthier fu
Page 149 and 150: # Standard Adapted from source shou
Page 151 and 152: # Standard Adapted from source Comm
Page 153 and 154: The final standards are more demand
Page 155 and 156: Figure 7.26: Proposed services to b
Page 157 and 158: Each CCG is taking steps to help pr
Page 159 and 160: in major hospitals) and equipment t
Page 161 and 162: tangible differences for patients
Page 163 and 164: Referral A&E Illustrative patient j
Page 165 and 166: Illustrative patient journey matern
Page 167 and 168: Illustrative patient journey in mat
Page 169 and 170: Illustrative patient journey planne
Page 171 and 172: GP-led care Illustrative patient jo
Page 173 and 174: 7.8.1 Scope of the CIG’s work The
Page 175 and 176: Theme Clinical outcomes Staff attit
Page 177 and 178: Further stakeholder engagement is n
Page 179 and 180: Figure 7.31 E&UC CIG Responses to N
Page 181 and 182: NCAT recommendation CIG response Se
Page 183: Conditions suitable for UCC Clinica
Page 187 and 188: Diagnostics 7.14.3 Streaming, regis
Page 189 and 190: Biochemistry Microbiology Radiology
Page 191 and 192: The Provider must deliver appropria
Page 193 and 194: Figure 7.41: E&UC CIG recommended k
Page 195 and 196: will be able to establish a service
Page 197 and 198: The UCC provider will be responsibl
Page 199 and 200: Key differences Governance As with
Page 201 and 202: should be provided with appropriate
Page 203 and 204: Process map 1: Assessing UCC patien
Page 205 and 206: Process map 3: UCC to ED transfer p
Page 207 and 208: make an appointment with their own
Page 209 and 210: 7.19 ED workforce A programme-wide
Page 211 and 212: The purpose of this section is to s
Page 213 and 214: Figure 7.45 Consultation results on
Page 215 and 216: Figure 7.46: Specific Responses the
Page 217 and 218: NCAT recommendation Original Progra
Page 219 and 220: 7.25.1 London Health Programmes cli
Page 221 and 222: Future capacity in centralised serv
Page 223 and 224: 3. There would be an additional "st
Page 225 and 226: in NWL will have a choice of delive
Page 227 and 228: Support for the proposal is higher
Page 229 and 230: Figure 7.49: Specific feedback the
Page 231 and 232: Sub-Theme Organisation Support Conc
Page 233 and 234: Sub-Theme Organisation Support Conc
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7.36.1 National Clinical Advisory T
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NCAT recommendation Further engagem
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edistributed nationwide. We envisag
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6. The Maternity CIG have considere
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DMBC Chapter 8A-E - Out of hospital
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Out of hospital improvements This c
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8.2. Settings of out of hospital ca
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practical solution for the site, wh
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Brent Health Partnerships Overview
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Consultation theme Standards for ca
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Consultation theme Integration Inve
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8.5.3. Workforce Following feedback
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Delivering this workforce shift wil
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Measure type Domain Potential measu
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8b. Primary care development 8.6. S
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consultation they could have receiv
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8.10. Next steps We are developing
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Figure 8.11: Hub/health centre requ
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some cases, these will be offered o
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Process for development of local ho
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The result is an emerging picture o
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Across NW London, these sites will
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need redeveloping or rebuilding to
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8d. Urgent care centres When indivi
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Figure 8.22: NW London urgent care
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Conditions suitable for UCC Clinica
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Key differences Governance As with
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processes of the CCG and as such th
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around the table accelerates the un
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Improved empowerment - specifically
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Figure 8.28: Realising our integrat
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Figure 8.29: Summary of CCG commiss
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DMBC Chapter 9 - Decision making an
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9a. Decision making analysis stages
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“The Brent Health Partnerships Ov
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Royal College of Midwives “The RC
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clinicians wanted to take this into
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9.6.3 Feedback received about the s
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Confirm the service models reflect
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Figure 9.9: The seven hurdle criter
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surgeons in NW London, but we would
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We confirmed this decision with the
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Appropriate staffing is integral to
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The proposals are supported by Depa
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NW London to deliver high quality c
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1. Support predicting where activit
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Figure 9.15: Example travel time ma
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The analysis shown in Figure 9.18,
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Figure 9.18: Impact on private car
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33% support 10% opposed 57% of peop
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Figure 9.21: Watershed map for blue
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etained as a major hospital, becaus
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9.7.29 The implications of this fee
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Figure 9.25: Potential activity flo
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Figure 9.27: Changes in travel time
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Figure 9.29: Changes in travel time
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Figure 9.31: Possible choices betwe
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Either Charing Cross or Chelsea & W
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Figure 9.33: Option A, excluding ca
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Figure 9.36: Option C responses, in
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Richmond Upon Thames LINk Royal Bor
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Southall Black Sisters “The closu
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Figure 9.38: Ranking of evaluation
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Figure 9.42: Evaluation criteria as
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anked third according to the mean s
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9.9.5 The analysis of the five eval
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Figure 9.45: Quality Dashboard data
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Response to feedback about the eval
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Figure 9.48: Quality of care - Acut
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experience. In order to use this as
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Figure 9.50: Time to major hospital
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Rationalising provision across the
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Figure 9.51: Blue light travel time
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Figure 9.52 shows the reduction in
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3 Value for money 9.9.26 The purpos
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Staff recommendation as a place to
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This analysis was agreed prior to c
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Figure 9.56: Ease of delivering eac
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Response to feedback about implemen
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Changes to the designation of the M
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5 Research and Education: Disruptio
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Figure 9.60: Evaluation of disrupti
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9.9.48 The outcome of the disruptio
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Greg Hands, MP for Chelsea & Fulham
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comprises more than 22 million cita
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Quality/Impact score Figure 9.65 Re
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9. Decision making analysis - stage
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There were six distinct parts of th
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Figure 9.69: 5 year gross savings,
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Figure 9.73: Commissioners intend t
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Figure 9.75: Beds bridge: 2012/13 t
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The key modelling assumptions appli
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Figure 9.79: DMBC NHS net capital e
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Figure 9.81: Approach to estimating
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Figure 9.84: Summary of net surplus
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Figure 9.86: Evaluation of total su
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9.13.9 Impact of the changes: Updat
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Figure 9.89: Effect of the expanded
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Sensitivity tests g) Tariff efficie
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Figure 9.93 summarises the impact o
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Figure 9.94: Change in expanded NPV
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The sensitivity analysis supports t
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DMBC Chapter 10 - The recommendatio
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10. The proposed future configurati
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The changes to the scoring before a
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10.3. Why this is the recommendatio
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In the rest of this section, the se
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