System challenges

The system challenges for Emergency Department services at Dorset County Hospital is illustrated below. 

The map below illustrates our Emergency Department system challenges, developed at a workshop on the 20th August 2019. Public Health Dorset facilitated workshops to help develop shared-understanding across Our Dorset towards a Joint Strategic Needs Assessment process. 

Particpants from the following organisations were in attendance: BCP Council, Dorset CCG, Parent Carers Together, Public Health Dorset.

The embedded Kumu map, below, is interactive:

• hover the mouse over an element of interest to see its immediate relationships
• left click and hold to refocus the map on that element
• to return to the wider map, left click and hold on any ‘white space’ in the map.

For greater interactivity and access to side panels containing additional information and links, follow the link under the embedded Kumu map (how do I read a systems map).

ED-Systems-Map-in-Kumu 

Logic model

This is the logic model of our theory-of-change for Emergency Department services provided by Dorset County Hospital. These services and the outcomes they are trying to achieve are illustrated here at a high level.

This work in progress identifies several key services and a wide range of sought after outcomes including shared understanding, improved quality of life and living life to its full potential.

The embedded Kumu map, below, is interactive. Hover the mouse over an element of interest to see its immediate relationships; left-click-and-hold to refocus the map on that element. To return to the wider map, left-click-and-hold on any ‘white space’ in the map. For greater interactivity and access to side panels containing additional information and links, follow the link under the embedded Kumu map (how do I read a logic model).

ED-Logic-Model-in-Kumu

Triangle of need

The number of people in the Dorset County Hospital catchment population recorded on their website is represented by the Triangle of Need.

ED-Triangle-of-Need-in-Tableau

Evidence base

Desired system change

Status: First draft of key areas indentified by the panel as having potential impact on the system challenges identified in the workshop process:

1. All issues revolve around the challenge of increasing demand for UEC
2. UEC demand is often defined in terms of necessary and unnecessary visit
3. Necessary visits require a better understanding of both the funding and structuring of internal capacity AS WELL AS working long-term to make sure preventative and alternative care services are appropriately funded.
4. Unnecessary visits, or visits that could have been prevented by accessing primary care or other services and/or having better shared-understanding of the alternatives, if prevented would allow stretched resources to be reallocated to people who have serious health issues that cannot be better treated elsewhere.
5. Some reduction in unnecessary visits are thought to be possible through better engagement and alignment with partner services including primary care, the ambulance service, and nursing homes.

Key questions

The key questions raised to futher knowledge around the desired system changes were:

• Do we have the workforce to enable prevention?
• Do we know enough about presentation at ED?
• How do we increase the detail of information on (1) the non-admitted, (2) sources-points of admissions, (3) formal and informal services and (4) advice prior to attendances?
• How sustainable is our workforce -- what are the opportunties to grow, retain, rotate rather than employ into new models?
• What are the unmet need for UEC and opportunintes to prevent admission?
• Can we improve the specificity in the recording of acuity, e.g. at presentation? * In particular, to define the divide between minor injury and minor ailment -- because we believe that almost all minor ailments/illness could be seen in primary care?
• Can we improve transport and access in primary care for Xray and rapid reporting (<2 weeks)? It would (1) improve primary care management, (2) USS --> referral and hospital for rapid access also CT rapid access.
• Can we educate population in better management of wounds and abrasions so that all issues are not run straight into UEC regardless of the time of day, which causes resourcing issues?

Additional input: We welcome further input — both from Panel and non-panel members.

Filling knowledge gaps
 

• Appropriate management frail elderly admissions
• Information on what presentations at ED are and what led to them
• Use of technology and IT to move practice to a more 'virtual environment'
• Use of technology and IT to nudge people into appropriate behaviours with regard to the use of UEC services
• Flexibility in funding to allow more flexible provision
• Potential impact in adopting large scale automation of key processes, such as * Pharmacy Robot for whole system (west) and whole county suplier
• Co-production of new service provisions
• Scope of what is required and identify who would fund development of UEC transformation