Emergency flow improvement tool: user guide

Transcription

1 Emergency flow improvement tool: user guide September 2017 Contents What is the emergency flow improvement tool?... 1 Accessing and navigating the flow tool... 2 Emergency flow improvement tool tab... 4 Flow dashboard tab... 5 Indicator detail tab... 9 What is the emergency flow improvement tool? The emergency flow improvement tool is a tableau-based tool which describes patient flow from arrival to discharge from acute hospitals. It uses indicators selected to highlight demand, pinch points and blocks. Each time series graph has been processed against six statistical process control (SPC) rules to highlight common cause (expected) and special cause (unexpected) variations. This tool also contains a benchmarking feature to allow a trust to be compared with other trusts inputting data into the tool. This tool acts, in part, as an improvement aid; allowing trusts and their stakeholders to visualise their data and prompt questions about their emergency flow. 1

2 Accessing and navigating the flow tool To access the emergency flow improvement tool, open this web address in your internet browser: The Model Hospital Login screen will be displayed. Click Login if you have an existing account. If you do not have an account click Register. This will take you to the registration screen. For more information regarding setting up your account, please refer to the OKTA registration guide. If you are unable to access this guide, please contact Having selected Login, the Model Hospital Sign In screen will be displayed. Enter your account details: your username (which should end and password. Tick the Remember me box to bypass this step in future. Click Sign In. 2

3 The Terms of Use/ Privacy policy screen will now be displayed Scroll down ensuring that you read the information thoroughly. Tick the tick box to confirm you agree with these terms and conditions and click Continue. The Model Hospital homepage will now be displayed, showing the key components which form the Model Hospital. Scroll down the Clinical Service Lines column and click the Emergency Medicine button 3

4 The Emergency Medicine Compartment screen will be displayed. Scroll down the sub-compartment sidebar on the right of the page and select Emergency Flow Information Tool. Emergency flow improvement tool tab The first tab (at the top of the screen) is the Emergency flow improvement tool tab. This page provides an overview of the tool, including information governance requirements, reporting frequency and contact details for tool support. 4

5 Flow dashboard tab The flow dashboard tab is the first chart to load once you have accessed the flow tool. It shows 28 indicators associated with the flow of patients through the urgent and emergency system. Describing the flow from arrival to discharge, each time series graph will have been processed against six statistical process control (SPC) rules to highlight common cause (expected) and special cause (unexpected) variations. Use the far left dropdown menu (in the top left-hand corner of the page, just below the title) to view and select a particular trust s or region s data. The drop-down menu is alphabetically ordered within regions listed at the top, followed by sub-regions and then trusts at the bottom. 5

6 If you select a trust that provides its type 1 A&E data broken down by sites, the second drop-down will display these sites beyond the (All) option. The flow dashboard shows the headline metric A&E 4-hour performance in the top left of the screen and staff sickness data alongside the Friends and Family Test at the bottom of the screen. The middle section of the tool illustrates the patient flow through the system, with indicators associated with arrival and assessment on the far left and those with discharge on the far right. Each indicator chart presents a time series graph of the data for the last 25 months with each data point (roundel) representing a calendar month s activity. 6

7 Each roundel of the data line can be defined by its colour - grey, blue or orange. Grey indicates a common cause (expected) variation and blue or orange a special cause (unexpected) variation. The colour of the special cause variation is determined by the indicator itself: orange indicates a special cause variation which may be a particular cause for concern such as increased waiting times; blue denotes a special cause variation which should be noted and investigated but may not have concerning implications such as a reduction in patients in bed at midnight. The number at the end of the chart is the activity for the latest monthly data point, again colour coded as described above. Finally, each chart is complimented by three parallel lines. The middle line of the three denotes the Mean for the data in this chart; the top and bottom parallel lines denote the upper and lower control limits respectively. Hover over a point or line on the graph to view the corresponding line or data type alongside the month in question. You can view the specific data point/indicator in more detail by clicking on any data point or line. This will take you to the Indicator Detail screen. A benchmarking icon appears next to each chart. This compares the trust s mean line with its peers in the dataset, coded as follows: 7

8 The benchmarking icons define activity as follows: Icon Icon definition Activity is much better than that of the other trusts in this dataset (the top performing 20th percentile) Activity is better than that of the other trusts in this dataset (between the top performing 20th and 40th percentiles) Activity is similar to that of the other trusts in this dataset (between the 40th and 60th percentiles) Activity is worse than that of the other trusts in this dataset (between the worst performing 20th and 40th percentiles) Activity is much worse than that of the other trusts in this dataset (the worst performing 20th percentile) Activity is on the high side compared with the other trusts in this dataset (highest 40th percentile) Activity is on the low side compared with the other trusts in this dataset (lowest 40th percentile) This activity has not been benchmarked This could be due to missing data, or a data view that does not make sense to benchmark. For example it would not make sense to benchmark a regional count of Arrivals against providers in the dataset. Quick tips: Note: the benchmarking icon is a comparative indicator, not a performance tool, so, for example, it may be perfectly reasonable for a smaller trust to show less activity. A breakdown of what each roundel represents is displayed at the bottom of the screen. 8

9 Indicator detail tab The Indicator Detail page can be viewed by clicking on a chosen indicator from the flow tool (as mentioned on page 7). This page will provide more in-depth information on the selected time series chart shown on the Flow Dashboard page. The table at the top of the screen (as shown here) displays the activity for each month with an accompanying matrix indicating the data points contributing to any unexpected special cause (blue/orange) variation. These are six special cause variation rules: outside control limit: coloured orange/blue if the monthly activity exceeds the upper or lower control limit (mean line ± 3σ (sigma)) run six points above/below mean: each month is coloured orange/blue if six or more points in a row are above or below the mean line 9

10 trend of six points: each month is coloured orange/blue if six or more points in a row follow a pattern of continual increase or decrease two of three points beyond 2σ: each month beyond 2σ is coloured whereby two of three points in a row exceed the 2σ limit (mean line ± 3σ) 15 consecutive points within 1σ: each month is coloured whereby 15 consecutive points are within the 1σ limit (mean line ± 3σ) Outside moving range limit: each month is coloured when the moving range value exceeds the moving range limit (moving range average * 2.66) see the Moving range mr-chart (below). You can identify the data type and date by hovering over a data point within the matrix. The middle section of the Indicator Detail view contains two charts. At the top is the x chart which shows a larger version of the corresponding flow chart on the flow tool. At the bottom is the Moving range mr-chart which shows the magnitude of change between two consecutive points from the x chart (always shown as a positive). A high number indicates a large variation between two consecutive points. If the value exceeds the moving range limit, this is an indication of a special cause variation. A benchmarking ribbon at the bottom of the screen indicates the position of the trust s mean data line (denoted by the blue circle) compared with that for other trusts (grey circles) inputting data to this tool. 10

11 Use the drop-down menu next to the Benchmarking title to select regions and trusts to compare. Quick tip: To revert to the main flow page at any stage, simply click the Flow Dashboard tab at the top of the page Please contact for support and queries regarding this tool. Alternatively call or improvement.nhs.uk NHS Improvement September