At least 3 of the following apply:- ED is experiencing a peak of demand of 12-19 patients per Escalate any patients with delays in assessment over 15 mins to the NIC who hour (or more) for 2 consecutive will divert resources to meet 15-minute assessment Ensure Matron, DHM are aware of total number of patients in ED with DTAs Risk of ambulance arrivals not having 15 minute Consultant in Charge will ensure: PITSTOP remains operational, junior doctors are Assessment supported in decision making, re-deployment of staff to meet demands Ensure PITSTOP does not delay ambulance offload when capacity across Majors A delay in referred patients being seen within 60 minutes are escalated to relevant Ambulances being held for 15-30 minutes on call consultant and Ops Centre notified Ensure all staff including FIT move suitable patients to the Discharge Lounge Failure to deliver PITSTOP process robustly to patients on Consider flexing criteria for EDU to enhance performance and minimise risk majors Escalate through Matron/HON and staffing meetings if not filling with NHSP and consider requesting Agency usage. Consider requesting additional HCSW to Delays in initial assessment(clinical) over 60 minutes replace 1 depending on skill mix. Increase ambulance streaming capacity More than 21 patients in total in ED (/Majors 1&2/ /Resus) Deployed additional staff and HCSW to ambulance streaming Medical staffing: ensure both ED and AMU juniors are seeing patients effectively. Unable to release the ambulance within 15 mins of arrival Support decision making across Majors to ED NiC and CiC to ensure DATIX is used to record any clinical impacts on patients as per ED Trigger list for incidents, ambulance holds, or failure to meet assessment Similar triggers apply to delays in Minors and Paediatrics. standards Triggers for delays in first and initial assessments combined Additional nursing staff allocated to initiate early ECG and observations with poor flow should be alerted to CIC and consultant/senior Review outcome of escalations doctor and nurse in PED 1 available space in Resus 2 + registered short on a shift. Lack of SpR on early, late or night shift or more than 1 SHO absent from single shift
At least 3 of the following apply:- ED is experiencing a peak of demand of 12-19 patients per hour (or more) for 2 consecutive Risk of ambulance arrivals not having 15 minute Assessment Ambulances being held for 15-30 minutes Failure to deliver PITSTOP process robustly to patients on majors Delays in initial assessment(clinical) over 60 minutes More than 21 patients in total in ED (/Majors 1&2/ /Resus) Unable to release the ambulance within 15 mins of arrival to ED Similar triggers apply to delays in Minors and Paediatrics. Triggers for delays in first and initial assessments combined with poor flow should be alerted to CIC and consultant/senior doctor and nurse in PED 1 available space in Resus 2 + registered short on a shift. Lack of SpR on early, late or night shift or more than 1 SHO absent from single shift Escalate any patients with delays in assessment over 15 mins to the NIC who will divert resources to meet 15-minute assessment Ensure Matron, DHM are aware of total number of patients in ED with DTAs Consultant in Charge will ensure: PITSTOP remains operational, junior doctors are supported in decision making, re-deployment of staff to meet demands Ensure PITSTOP does not delay ambulance offload when capacity across Majors A delay in referred patients being seen within 60 minutes are escalated to relevant on call consultant and Ops Centre notified Ensure all staff including FIT move suitable patients to the Discharge Lounge Consider flexing criteria for EDU to enhance performance and minimise risk Escalate through Matron/HON and staffing meetings if not filling with NHSP and consider requesting Agency usage. Consider requesting additional HCSW to replace 1 depending on skill mix. Increase ambulance streaming capacity Deployed additional staff and HCSW to ambulance streaming Medical staffing: ensure both ED and AMU juniors are seeing patients effectively. Support decision making across Majors NiC and CiC to ensure DATIX is used to record any clinical impacts on patients as per ED Trigger list for incidents, ambulance holds, or failure to meet assessment standards Additional nursing staff allocated to initiate early ECG and observations Review outcome of escalations
Capacity%20Management%20Policy%20inc%20Escalation%20Measures.DOCX