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Along with other NHS Trusts, we have a range of different targets relating to infections, waiting times and other measures. You can read more about these here.

Performance and Quality

Treating emergency patients

The national target for emergency department waiting times is for 95% of patients to be admitted, discharged or transferred as appropriate within four hours of their arrival at hospital. For 2015/16, 93.33%* [ of patients were admitted, discharged or transferred within four hours. Like other hospitals, we have seen an increase in emergency attendances and patients who need admitting to a hospital bed from the emergency department. Among these have been an increase in sicker patients who required more complex care and treatment. In addition we have seen a significant increase and consistently high numbers of patients in hospital beds who although medically fit and ready for discharge, have been unable to be discharged due to challenges in providing the appropriate support outside of hospital. This has a huge impact on the flow of patients through the hospital resulting in increased pressure on the emergency department.

* Includes type 1, 2 and 3 attendances.

We implemented a range of measures to help manage these pressures, including opening additional beds and working with partners in the community to improve access to healthcare in the community and directing patients to alternative options rather than attending our emergency department.

Meeting our infection control targets

There have been 29 cases of C.difficile against a target of 44, which is a significant improvement from last year, when we had 42 cases. There has also been significant improvement in the number of patients with MRSA blood stream infections. We had two this year, compared to seven and eight in the two previous years, however the target remains zero. Each case of C. diff or MRSA is subject to a root cause analysis investigation and lessons learned are cascaded across the organisation. Our focus on line care and aseptic non-touch technique remains constant along with the prompt recognition and management of patients with diarrhoea.

Postponed operations


During the year, we have worked to minimise the number of cancelled operations on the day of surgery for non-clinical reasons, and to ensure that if an operation has to be cancelled, our patients are given a new date which is within 28 days from their original date. However, an increase in emergency admissions throughout the year means that we have cancelled more operations than we would like. This year we had to cancel 374 operations, which is 0.67% of our total operations carried out.

18 weeks

We narrowly missed the national standard of ensuring patients are treated within a maximum of 18 weeks from their referral. 91.19% of patients were waiting less than 18 weeks against a target of 92%. We have seen a substantial increase in our activity, particularly with urgent procedures and have experienced staff sickness within our surgical teams. We have also undertaken a transfer of regional upper GI surgery from other local trusts that has increased demands on services. Later in the year, national industrial action also impacted on our ability to ensure at least 92% of patients would receive their treatment within 18 weeks of referral. We are recruiting more surgeons and anaesthetists and are working with local partners to share capacity across the health economy.

 

 

Easy Read Information

This page has information about the quality of our work. It also has information about how long patients have to wait before being seen.

Our Targets

Along with other NHS Trusts, we have a range of different targets relating to infections, waiting times and other measures. You can read more about these here

Treating emergency patients

Tin 2016-17 89% of patients requiring treatment for an accident or emergency were admitted, transferred or discharged within four hours of arrival. Whilst this is below the national standard of 95% or patients, it is in line with other comparable trusts across the country. In 2016-17, there were over 91,500 attendances to the emergency department at the Royal. This is around 7,600 a month, 1,700 a week, 250 a day.

Like other hospitals, we have seen an increase in emergency attendances and patients who need admitting to a hospital bed from the emergency department. In 2016-17, a quarter of people attending the Royal’s emergency departments (including St Paul’s Eye Clinic) were admitted to hospital. Among those requiring admission 46% were aged 65 or over. These patients tend to be more unwell and often require more complex care, treatment and various tests. They also often require complex care and support in the community once they are discharged. This has a significant impact on the flow of patients through the hospital resulting in increased pressure on the emergency department.

Patient flow improvements

Like many hospitals across the country, the Trust faced significant challenges in meeting high demand and achieving a smooth flow of patients through the hospital. Frequently throughout the year there have been over 100 patients in hospital beds who were ready to be discharged. The majority have been waiting for care packages in the community to support their discharge and have had to remain in hospital despite being medically fit to leave. By working across teams within the Trust and closely with local partners in health and community care, a number of improvement projects have been introduced to improve patient flow.

Postponed operations

During the year, we have worked to minimise the number of cancelled operations on the day of surgery for non-clinical reasons, and to ensure that if an operation has to be cancelled, our patients are given a new date which is within 28 days from their original date. However, an increase in emergency admissions throughout the year means that we have cancelled more operations than we would like. This year we had to cancel 398 operations, which is 0.69% of our total operations carried out.

18 weeks

We narrowly missed the national standard of ensuring patients are treated within a maximum of 18 weeks from their referral. 90% of patients were waiting less than 18 weeks against a target of 92%. We have seen a substantial increase in our activity, particularly with urgent procedures and have experienced staff sickness within our surgical teams. We have also undertaken a transfer of regional upper GI surgery from other local trusts that has increased demands on services. Later in the year, national industrial action also impacted on our ability to ensure at least 92% of patients would receive their treatment within 18 weeks of referral. We are recruiting more surgeons and anaesthetists and are working with local partners to share capacity across the health economy.