Report evidence summary
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 27
Action
Align senior medical staffing hours with peak ED demand, including extended consultant cover.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Open additional surge inpatient bed capacity during peak demand when staffing permits safe operation.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Review and amend medical and nursing rotas to reflect ED demand and increase senior cover.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Introduce Treatment Escalation Plans for nursing and residential homes to support safe care without ambulance conveyance.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Develop guidance for ambulance resources supporting patient discharge, transfer, routine transport, and repatriation.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Staff additional holding areas away from ED during extreme pressure to support patient flow.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Implement the SAFER patient-flow bundle across all three acute hospital sites, supported by senior clinical leadership and communications.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Operate the Local Escalation Action Plan to minimise ambulance handover delays, including hospital liaison support.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Provide triage, medical review, harm review, and physiological monitoring for patients delayed in ambulances at Ysbyty Glan Clwyd.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Apply paramedic guidance for identifying patients suitable for handover to the ED waiting room.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Operate a rapid assessment unit at Ysbyty Maelor Wrexham to assess and admit ED and GP patients promptly.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source
Action
Operate a Step Down Manager role coordinating transfers of patients with complex care needs to appropriate next-stage services.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Increase Clinical Support Desk staffing by up to 30 whole-time equivalents using secured Welsh Government funding.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source
Action
Conduct daily discharge-focused board rounds and weekly reviews of delayed transfers of care at both hospital sites.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Open three additional ED rooms for minor injuries, emergency nurse practitioners, and GP out-of-hours services.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Implement an escalation protocol for safely managing delayed ambulance handovers and releasing ambulances for urgent calls.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Recruit permanent medical staff for Ysbyty Maelor Wrexham’s middle-grade, SHO, and consultant vacancies.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Introduce unified assessment documentation for patients awaiting admission from ED.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Increase specialty medical and surgical in-reach to assess ED patients before inpatient admission.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Expand Ysbyty Glan Clwyd ED capacity through additional assessment spaces, observation beds, and flexible use of available clinical areas.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Operate the Clinical Support Desk to provide telephone clinical triage and direct patients to appropriate care pathways.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Recruit additional ED nursing and medical staff and increase the funded staffing establishments.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Establish a Night Sister post to support clinical site management, patient flow, quality, and safety.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Use demand-management communications and escalation between ambulance and hospital senior managers during handover delays.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Explore establishing a Rapid Assessment and Treatment area at Ysbyty Glan Clwyd.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source
Action
Provide overnight district nursing in Wrexham to support safe care at home instead of hospital stays.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source
Action
Operate the clinical response model that prioritises life-saving ambulance calls and provides bespoke responses for other patients.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source See 24 more actions
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to ensure availability of resources
Wider context from the report “The issues of ambulance delays/admission to ED/availability of resources /patient flow and the multifactorial problems associated with cases of this nature have been reported upon by me on several occasions following previous inquests.
Despite the above reports issued to the Health Board and Ambulance Service these problems continue to the present day and patients’ lives are being placed at risk as a result.
” Is this part of a recurring concern? No recurring-concern membership is currently published.
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure of patient flow processes
Wider context from the report “The issues of ambulance delays/admission to ED/availability of resources/patient flow and the multifactorial problems associated with cases of this nature have been reported upon by me on several occasions following previous inquests.
Despite the above reports issued to the Health Board and Ambulance Service these problems continue to the present day and patients’ lives are being placed at risk as a result.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Continuing problems with admission to the emergency department
Wider context from the report “The issues of ambulance delays/admission to ED /availability of resources/patient flow and the multifactorial problems associated with cases of this nature have been reported upon by me on several occasions following previous inquests.
Despite the above reports issued to the Health Board and Ambulance Service these problems continue to the present day and patients’ lives are being placed at risk as a result.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Continuing ambulance delays
Wider context from the report “The issues of ambulance delays /admission to ED/availability of resources/patient flow and the multifactorial problems associated with cases of this nature have been reported upon by me on several occasions following previous inquests.
Despite the above reports issued to the Health Board and Ambulance Service these problems continue to the present day and patients’ lives are being placed at risk as a result.
” Is this part of a recurring concern? Yes — Delays in ambulance attendance .
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Align senior medical staffing hours with peak ED demand, including extended consultant cover.
Verbatim wording from the response “• The service is also working towards better matching senior medical staff working hours with times of peak patient demand. The aim is to have the Consultant late day shift extended from 18.00hrs to 22.00hrs and have a second Consultant working until 9pm Monday to Friday” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Open additional surge inpatient bed capacity during peak demand when staffing permits safe operation.
Verbatim wording from the response “• During times of peak demand, additional ‘surge’ inpatient bed capacity is opened in line with available staffing. This includes the use of medical and surgical assessment spaces as overnight inpatient beds and the escalation of additional beds on some wards where staffing levels enable this to be done safely.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review and amend medical and nursing rotas to reflect ED demand and increase senior cover.
Verbatim wording from the response “• Medical and nursing staffing rotas have been reviewed and amended to better reflect the peaks of patient demand in ED and changes have also been made to increase the senior level cover in the department.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce Treatment Escalation Plans for nursing and residential homes to support safe care without ambulance conveyance.
Verbatim wording from the response “Complimenting this work by WAST are a range of BCUHB initiatives to reduce ambulance conveyance/ED attendance. These include:” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop guidance for ambulance resources supporting patient discharge, transfer, routine transport, and repatriation.
Verbatim wording from the response “Healthcare Inspectorate Wales is soon due to commence a patient discharge thematic review within BCUHB which may identify new actions for the Health Board and possibly its partners to complete to realise improvements to the discharge planning process. WAST is currently developing ‘Patient Transfer, Discharge, Routine and Repatriation Guidance’ to ensure that WAST and the wider NHS community fully understand the process of requesting an ambulance resource for particular groups of patients who need transport to enable their discharge/transfer to another facility. This will help ensure timely discharge using the most appropriate resource whilst also maintaining the availability of WAST resources to respond to 999 calls.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Staff additional holding areas away from ED during extreme pressure to support patient flow.
Verbatim wording from the response “• In times of extreme pressure, additional holding areas are staffed away from ED to assist with the pull through of patients from ED to sustain flow of emergency patients.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement the SAFER patient-flow bundle across all three acute hospital sites, supported by senior clinical leadership and communications.
Verbatim wording from the response “4.3. SAFER
BCUHB has committed to implement the SAFER bundle in all 3 acute hospital sites over the next 6 months. This is an evidence based bundle of actions shown to reduce length of stay and support safe patient discharge. The key elements of this are:” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate the Local Escalation Action Plan to minimise ambulance handover delays, including hospital liaison support.
Verbatim wording from the response “With WAST, BCUHB has also developed a Local Escalation Action Plan (LEAP) which clearly outlines the escalation processes for WAST and BCUHB staff to apply to enable ambulance crews to hand over patients to ED with minimum delay. As part of the ‘LEAP’ protocol, WAST provides a Hospital Ambulance Liaison Officer (HALO) or a Duty Operational Manager (DOM) at hospitals when ambulances are delayed. These are usually WAST Clinical Team Leaders whose role is to supervise crews experiencing handover delays and liaise directly with ED.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide triage, medical review, harm review, and physiological monitoring for patients delayed in ambulances at Ysbyty Glan Clwyd.
Verbatim wording from the response “For Ysbyty Glan Clwyd, patients who cannot be immediately accommodated into a clinically appropriate ED space will undergo a triage assessment by an ED nurse and a clinical medical review. Patients held in an ambulance for an hour or more will have a full ‘harm’ review to commence assessment/treatment and ensure their care outcome is not compromised. The recording of patients’ vital signs including the National Early Warning Score (NEWS) is routinely recorded as part of these assessments and is integrated into the paramedics’ patient record.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Apply paramedic guidance for identifying patients suitable for handover to the ED waiting room.
Verbatim wording from the response “The WAST Clinical Contact Centre (CCC) uses a demand management plan to ensure good communications with hospital sites about WAST community activity and demand, particularly during times of handover delays. Delays are escalated to a WAST senior manager who liaises with senior BCUHB officers to agree how resources can be safely released to respond to WAST community activity.
WAST and BCUHB have together developed guidance for paramedics to identify patients well enough to be placed in the ED waiting room, rather than wait on an emergency ambulance.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate a rapid assessment unit at Ysbyty Maelor Wrexham to assess and admit ED and GP patients promptly.
Verbatim wording from the response “• From the 1st August 2017, a rapid assessment unit will be operational to assess and admit patients from ED (and GPs) without undue delay. From the autumn, this will be complimented with a Frailty Assessment Unit with a focus on admission avoidance to return individuals to their own homes with the support of community staff, including therapists. The unit will provide rapid assessment and treatment of patients who have the potential to return home the same day or within a maximum of 72 hours. Patients will be treated as ambulatory until proven otherwise and within the unit, individuals will receive rapid diagnosis and stabilisation before they are supported home.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate a Step Down Manager role coordinating transfers of patients with complex care needs to appropriate next-stage services.
Verbatim wording from the response “• A ‘Step Down’ Manager post has been created who works collaboratively with community health and social care colleagues to ensure that patients with complex care needs are moved to the next stage of their care pathway without undue delay (this may be: placement in a nursing/residential home, transfer to a community hospital or back to their own homes with packages of support). However local” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Increase Clinical Support Desk staffing by up to 30 whole-time equivalents using secured Welsh Government funding.
Verbatim wording from the response “1.2. Increase effectiveness of the Clinical Support Desk
As the result of a service improvement initiative, WAST has invested in a Clinical Support Desk within the Clinical Contact Centre (CCC). This means that a clinician (nurse / paramedic) is available to clinically assess, through telephone triage, the needs of patients and advise on appropriate alternative care pathways or conveyance. This initiative has proved highly successful, resulting in an average of 2,500 calls per month having a non-ambulance outcome, thereby substantially reducing ambulance conveyances to hospital. Following the success of this initiative, WAST has successfully presented a business case to the Ambulance Services Commissioner and Welsh Government and has received funding from Welsh Government to increase the clinicians employed in the clinical support desk for up to 30 whole time equivalents.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct daily discharge-focused board rounds and weekly reviews of delayed transfers of care at both hospital sites.
Verbatim wording from the response “5. Improvement in the discharge/transfer of care of patients at the end of their acute hospital stay.
As well as the actions outlined above, BCUHB works collaboratively with WAST and Local Authorities to support the safe discharge/transfer of care of patients following their acute hospital stay to ensure patients don’t remain in hospital longer than they require. At both Ysbyty Maelor Wrecsam and Ysbyty Glan Clwyd, there is a strong focus on early identification of patients who are medically fit for discharge to ensure timely discharge. Daily ‘board rounds’ are held across acute adult wards to ensure daily discussion of each patient and their care needs, including discharge planning as appropriate with local authority colleagues. There is a weekly review at both hospital sites of patients experiencing a ‘Delayed Transfers of Care’ (DTOC).” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Open three additional ED rooms for minor injuries, emergency nurse practitioners, and GP out-of-hours services.
Verbatim wording from the response “• 3 additional rooms in ED have been opened for Minors patients, the ENP service and GP Out of Hours services.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement an escalation protocol for safely managing delayed ambulance handovers and releasing ambulances for urgent calls.
Verbatim wording from the response “BCUHB has developed an escalation protocol to ensure a consistent approach to the safe management of patients whose handover is delayed. This is to support the procedure to enable the immediate release of delayed ambulances to enable WAST to respond to life threatening or clinically urgent 999 calls in the community (the immediate release system).” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit permanent medical staff for Ysbyty Maelor Wrexham’s middle-grade, SHO, and consultant vacancies.
Verbatim wording from the response “• The recruitment of medical staff is ongoing to improve cover of the medical rota from August 2017 at middle grade and SHO level. There are 2 wte Consultant vacancies currently covered with locum Consultants. There is a focused campaign of work ongoing to recruit to these key posts on a permanent basis.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce unified assessment documentation for patients awaiting admission from ED.
Verbatim wording from the response “• A modified form of unified assessment documentation for patients awaiting admission from ED has been under development. This supports the provision of inpatient level type care to ED patients, ensuring their clinical outcomes and treatment is not compromised. It is intended to fully introduce this process in early August, following a period of trial to ensure all documentation and processes are fully fit for purpose.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Increase specialty medical and surgical in-reach to assess ED patients before inpatient admission.
Verbatim wording from the response “• Work is also on-going to increase specialty ‘in reach’ into ED by medical and surgical specialties who attend ED to review patients rather than wait for them to be admitted to an inpatient ward. This does result in some patients being discharged home from ED.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Expand Ysbyty Glan Clwyd ED capacity through additional assessment spaces, observation beds, and flexible use of available clinical areas.
Verbatim wording from the response “• A review of the use of the physical space within ED has created an open ambulatory chair centric area with 4 additional assessment/treatment spaces; the commissioning of 2 additional beds in the observation bedded area of the ED; the use of the co-located GP Out of Hours area during the day (Monday to Friday, 9am - 5pm) to provide 4 rooms for assessment / treatment; and the adoption of a flexible approach, in extenuating circumstances, to the use of all space within the ED during times of peak pressure.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate the Clinical Support Desk to provide telephone clinical triage and direct patients to appropriate care pathways.
Verbatim wording from the response “1.2. Increase effectiveness of the Clinical Support Desk
As the result of a service improvement initiative, WAST has invested in a Clinical Support Desk within the Clinical Contact Centre (CCC). This means that a clinician (nurse / paramedic) is available to clinically assess, through telephone triage, the needs of patients and advise on appropriate alternative care pathways or conveyance. This initiative has proved highly successful, resulting in an average of 2,500 calls per month having a non-ambulance outcome, thereby substantially reducing ambulance conveyances to hospital. Following the success of this initiative, WAST has successfully presented a business case to the Ambulance Services Commissioner and Welsh Government and has received funding from Welsh Government to increase the clinicians employed in the clinical support desk for up to 30 whole time equivalents.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit additional ED nursing and medical staff and increase the funded staffing establishments.
Verbatim wording from the response “• On-going recruitment of nursing and medical staff is a key focus. This has resulted in an increase in the funded nursing establishment in ED from 56 WTE to 94 WTE, and an increase in funded medical staff posts to double the posts from 4 to 8 full time Consultants and from 5 to 8 middle grade senior doctors. It will take time to attract and recruit substantive staff to all posts although recent recruitment campaigns for senior medical staff have met with success. It is anticipated that the Consultant and senior middle grade doctor posts will all be filled with substantive appointments by the end of 2017. Until this time, the service is employing locum medical staff to provide as much service cover and continuity of care as possible.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish a Night Sister post to support clinical site management, patient flow, quality, and safety.
Verbatim wording from the response “• A Night Sister post has been put in place to assist the Clinical Site Manager with patient flow and associated quality and safety issues” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Use demand-management communications and escalation between ambulance and hospital senior managers during handover delays.
Verbatim wording from the response “The WAST Clinical Contact Centre (CCC) uses a demand management plan to ensure good communications with hospital sites about WAST community activity and demand, particularly during times of handover delays. Delays are escalated to a WAST senior manager who liaises with senior BCUHB officers to agree how resources can be safely released to respond to WAST community activity.
WAST and BCUHB have together developed guidance for paramedics to identify patients well enough to be placed in the ED waiting room, rather than wait on an emergency ambulance.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Explore establishing a Rapid Assessment and Treatment area at Ysbyty Glan Clwyd.
Verbatim wording from the response “At Ysbyty Maelor Wrecsam, a holding area in ED is created whenever possible during the day to enable patients of low risk to be handed over without delay by WAST and brought into ED. At Ysbyty Glan Clwyd, options are being explored to establish a physical ‘RATS’ (Rapid Assessment & Treatment Service) area in ED to enable the rapid handover and assessment of patients.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide overnight district nursing in Wrexham to support safe care at home instead of hospital stays.
Verbatim wording from the response “• During times of peak demand, additional ‘surge’ inpatient bed capacity is opened in line with available staffing. This includes the escalation of additional beds on some wards where staffing levels enable this to be done safely. The District Nursing Service in Wrexham is now available overnight, enabling more patients to be safely cared for at home rather than remain in hospital.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate the clinical response model that prioritises life-saving ambulance calls and provides bespoke responses for other patients.
Verbatim wording from the response “In October 2015 WAST introduced a new clinical response model to implement new ways in which callers to 999 are assessed. This sought to ensure that patients and users of the service received the most appropriate care and a response to suit their individual needs. The changes made clearly identify those patients who require an immediate life-saving response and these patients receive the highest priority response in the fastest possible time.
All other patients receive a bespoke clinical response based on their condition, rather than a response based solely on a time standard. These changes sought to improve the patient’s care, outcome and experience, as well as improve patient flow into hospitals.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establishing a North Wales Bed Bureau was not considered feasible for improving acute hospital access because of geography and local-admission priorities.
Verbatim wording from the response “In reviewing the action plans already submitted in response to previous Regulation 28 reports relating to patient flow, BCUHB notes that all previous actions have been implemented or are work in progress, with the exception of the establishment of a North Wales Bed Bureau. After consideration of this, it was not deemed a feasible way of improving access for acute hospital admissions across North Wales due to geography and enabling the admission of emergency patients to as local a hospital as possible, as often as possible.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 17 1 Evaluate the Manchester Triage System trial to inform potential alternative-pathway rollout.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 2 Develop enhanced multidisciplinary community resource teams to provide more care in patients’ homes.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 3 Protect staffing and clinical space for the emergency nurse practitioner service treating minor injuries.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source 4 Triage suitable ED self-presenters into the co-located GP out-of-hours service and provide daytime GP assessment.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 5 Develop and implement alternative emergency care pathways through joint clinically focused workshops and prioritised workstreams.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 6 Operate a falls strategic improvement group to improve assessment and response across the five-step model.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated completedThe respondent said that this action was complete when they made their response on 31 August 2017. View source 7 Introduce a North Wales service providing alternative community care for frequent ambulance callers.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source 8 Develop and implement an alternative care pathway for patients experiencing mental-health distress.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 9 Implement a North Wales-wide falls pathway for patients who fall at home.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source 10 Increase Minor Injury Unit access by reviewing criteria, extending opening times, ensuring nurse-led provision, and publicising availability.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 11 Continue developing the intravenous therapy suite to provide day treatment without overnight admission.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 12 Implement improved risk-escalation systems for unscheduled-care demand, initially at Ysbyty Glan Clwyd.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 13 Develop WAST’s paramedic clinical-leadership structure, including appointing an Assistant Director of Paramedicine.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 14 Implement the Mental Health Improvement Plan, including evidence-based staff training and risk-assessment tools.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 15 Develop alternative care pathways for catheter management, palliative care, end-of-life care, and falls.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated in progressThe respondent said that this action was in progress when they made their response on 31 August 2017. View source 16 Trial a Frailty Assessment Unit at Ysbyty Maelor Wrexham to support same-day or short-stay treatment and admission avoidance.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source 17 Trial a Frailty Assessment Unit at Ysbyty Glan Clwyd to support admission avoidance and community care.
Stated by Betsi Cadwaladr University LHB and Welsh Ambulance Services NHS Trust Stated plannedThe respondent said that this action was planned when they made their response on 31 August 2017. View source
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Evaluate the Manchester Triage System trial to inform potential alternative-pathway rollout.
Verbatim wording from the response “• Paramedic Pathfinder
The demand for emergency ambulance attendance is increasing year on year. Many patients can be treated through safe alternatives to transportation to an ED. Paramedic Pathfinder has been designed to support ambulance clinicians in assessing patients in the pre-hospital environment. It does this by enabling the exclusion of serious discriminators before any consideration is given to an alternative pathway of care other than conveyance to an ED. WAST is currently undertaking a trial of the Manchester Triage System (decision support tool) in the Abertawe Bro Morgannwg University Health Board area. This will be evaluated for potential future roll out across Wales to inform alternative pathway development.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop enhanced multidisciplinary community resource teams to provide more care in patients’ homes.
Verbatim wording from the response “• Developing enhanced multi-disciplinary community resource teams (CRT) to provide more care for individuals in their own homes. The CRTs are in varying degrees of development across North Wales and whilst have the potential to better manage care closer at home need to build on the range of successful intermediate care provision already delivered in the 6 local authorities.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Protect staffing and clinical space for the emergency nurse practitioner service treating minor injuries.
Verbatim wording from the response “• The ENP service has protected staffing and clinical space to ensure patients with minor injuries are treated in a timely manner.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Triage suitable ED self-presenters into the co-located GP out-of-hours service and provide daytime GP assessment.
Verbatim wording from the response “• Work is also underway with the co-located GP Out of Hours service in the ED department to identify more suitable patients through the triage of self-presenting patients to ED for ‘pull’ into the GP Out of Hours service.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop and implement alternative emergency care pathways through joint clinically focused workshops and prioritised workstreams.
Verbatim wording from the response “WAST has been working with BCUHB to develop new services and alternative care pathways. Lately, this has included holding a series of joint, clinically focused workshops across North Wales to review, identify and implement new emergency care pathways that WAST can access, some of which have been agreed in other parts of Wales. The final workshop took place on 7th July following which a number of key innovations, work streams and care pathways have been prioritised. A clear priority identified will include having a focus on improving the management and care of patients who fall at home (referred to separately in more detail later in this section of the response). The detail of the Unblocking Innovation events is attached as Appendix 1.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate a falls strategic improvement group to improve assessment and response across the five-step model.
Verbatim wording from the response “WAST has established a falls strategic improvement group to focus on improving the assessment and response to patients who have fallen across the 5 step model to inform a ‘once for wales’ approach to falls.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce a North Wales service providing alternative community care for frequent ambulance callers.
Verbatim wording from the response “1.3. Frequent Caller Initiative
A number of patients repeatedly access the 999 emergency ambulance service where alternative care may be more appropriate for them. These individuals often have complex health and / or social needs and may have disengaged from appropriate care services.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop and implement an alternative care pathway for patients experiencing mental-health distress.
Verbatim wording from the response “In addition, a key priority is to develop alternative care pathways for patients experiencing mental health distress to ensure that wherever appropriate conveyance to an ED is avoided. In other parts of NHS Wales, WAST has successfully developed joint pathways with mental health crisis teams. This learning has been shared with” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement a North Wales-wide falls pathway for patients who fall at home.
Verbatim wording from the response “• Falls: The Clinical Support Desk is working collaboratively with Wrexham Fire Service and North Wales Police to provide care and assistance to non-injury fallers within the community setting. The fire service will respond and assist the patient and while doing so, undertake preventative work including surveying the house for any immediate fall hazard risks, security and fire prevention.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Increase Minor Injury Unit access by reviewing criteria, extending opening times, ensuring nurse-led provision, and publicising availability.
Verbatim wording from the response “1.1 Minor Injury Units (MIU)
The Head of Operations for WAST has been leading work with BCUHB to increase the access to and use of MIUs by WAST, supported by a joint steering group which aims to:” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue developing the intravenous therapy suite to provide day treatment without overnight admission.
Verbatim wording from the response “• The provision of an IV suite continues to develop as an important service to enable individuals to receive IV therapy as a day attender (both emergency and elective) without the need for an overnight hospital stay.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement improved risk-escalation systems for unscheduled-care demand, initially at Ysbyty Glan Clwyd.
Verbatim wording from the response “In addition through the spring and summer 2017, BCUHB, WAST and key partners have held a number of events with frontline staff to examine, explore and find solutions to the current service pressures, these were called Innovation Unblocked. Through these engagement events staff have identified very practical solutions of how systems can be improved to support flow. These events have also identified key pathways that need to be developed to avoid hospital admission or to improve patient access to the right services avoiding unnecessary attendance to the Emergency Department.
To compliment this work, the Delivery Unit (DU), is also supporting BCUHB to implement improved risk escalation systems in managing unscheduled care demand. This is initially focussed on acute hospital sites to increase patient safety. The DU is initially focusing on providing this support at Ysbyty Glan Clwyd.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop WAST’s paramedic clinical-leadership structure, including appointing an Assistant Director of Paramedicine.
Verbatim wording from the response “A key priority area for WAST, identified in the service’s Integrated Medium Term Plan, is the development of its paramedic workforce. Following the changes to the WAST clinical response model outlined earlier, the service is becoming a more clinically focussed service, requiring the complimentary development of a clinical leadership structure to support paramedics to work their full scope of practice. This will in turn enable them to identify more patients suitable for alternative care pathways to conveyance to ED. This work has already commenced with the appointment of a new Assistant Director of Paramedicine.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement the Mental Health Improvement Plan, including evidence-based staff training and risk-assessment tools.
Verbatim wording from the response “• Mental Health: As a result of both service user and staff feedback, WAST has developed a Mental Health Improvement Plan outlining 6 priority areas for those with mental health needs. This includes supporting WAST staff through the use of an assessment of the patient’s mental health illness or mental distress. This will be based on using up to date evidence based education and training and developing risk assessment tools for frontline clinicians to support their decision making.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop alternative care pathways for catheter management, palliative care, end-of-life care, and falls.
Verbatim wording from the response “• Developing a range of alternative care pathways including for catheter management, palliative/end of life care at home or in a nursing/residential home and work with WAST to develop a number of alternative care pathways including one for falls (see below). One authority already provides a successful palliative care service on behalf of the health service and the local authorities are keen to enhance services they could be commissioned to provide.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Trial a Frailty Assessment Unit at Ysbyty Maelor Wrexham to support same-day or short-stay treatment and admission avoidance.
Verbatim wording from the response “• From the 1st August 2017, a rapid assessment unit will be operational to assess and admit patients from ED (and GPs) without undue delay. From the autumn, this will be complimented with a Frailty Assessment Unit with a focus on admission avoidance to return individuals to their own homes with the support of community staff, including therapists. The unit will provide rapid assessment and treatment of patients who have the potential to return home the same day or within a maximum of 72 hours. Patients will be treated as ambulatory until proven otherwise and within the unit, individuals will receive rapid diagnosis and stabilisation before they are supported home.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Trial a Frailty Assessment Unit at Ysbyty Glan Clwyd to support admission avoidance and community care.
Verbatim wording from the response “• In early autumn, a Frailty Assessment Unit will be trialled, providing a more comprehensive assessment of frail patients at the ‘front door’ with the aim of avoiding admission for some of these by providing additional community support to enable patients to be safely managed in their own homes. This needs further discussion with the local authorities.” Source location 2017-0167-Response-by-University-Health-Board
Open published response
Pin
Get email alerts
Request correction
Information checked against the published report and official responses