Dr Anne Talbot, Clinical Director, Bolton Community Practice, National Clinical Lead, introduces the Urgent Care Clinical Dashboard, making the best use of data across boundaries.

1. Clinicians driving clinical dashboards: Making best use of data across boundaries (integrating urgent care management) Dr Anne Talbot, National Clinical Lead, Urgent Care Clinical Dashboard

3. Identified benefits in the pilot dashboard site and developments in pioneer sites

6. utilising multiple sources of existing data, even across organisational boundaries and providing information for use across multidisciplinary teams

8. Integration of information from multiple source systems Information From Acute Trust Walk in CentrePatient Attendance DatePatientM 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 A&E AttendancesPatient Attendance DatePatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 PatientK 03/02/2009 Information received separately from multiple sources within different time frames – making identifying patterns difficult PatientK 03/02/2009 PatientK 08/02/2009 Out Of HoursPatient Contact DatePatientT 01/02/2009 PatientY 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 AdmissionsPatient Admission DatePatientA 01/02/2009 PatientH 04/02/2009 PatientK 08/02/2009 PatientK 02/02/2009 DischargesPatient Discharge DatePatientA 08/02/2009 Information From Practice PatientK 08/02/2009 Practice Disease RegisterPatient RegisterPatientT Diabetes PatientS CHD PatientK COPD Current Position

9. Integration of information from multiple source systems Information From Acute Trust WiC WiC Patient Attendance DatePatientM 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 A&E A&E A&E Patient Attendance DatePatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 Clinical Dashboard:Patient Drilldown - PatientK PatientK 03/02/2009 PatientK 02/02/2009 PatientK 08/02/2009 OOH OOH COPD Patient Contact DatePatientT 01/02/2009 PatientY 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009PatientJ 04/02/2009 Admission Admission COPD Patient Admission DatePatientA 01/02/2009 PatientH 04/02/2009 COPD PatientK 03/02/2009 PatientK 08/02/2009 COPD COPD Discharge Discharge Information From Practice Patient Discharge DatePatientA 08/02/2009 COPD Practice Disease RegisterPatient RegisterPatientT Diabetes PatientS CHD PatientK 08/02/2009 PatientK COPD

10. NHS Bolton’s dashboard interface Enables GPs, nurses and active case managers to monitor their own patients' recent attendances at A&E and out-of-hours services, and to highlight which of these patients are on disease registers.

11. NHS Bolton: patient level drill downs

13. Practice operational level − identifies issues of primary care access

14. PCT operational level − identifies poor patient pathways, areas of training need across professional groups

15. PCT strategic level − tool linked to strategic aims, objectives and plans; public media campaign NHS Bolton achieved a reduction in A&E attendance of 3.14% and a reduction in non-elective admissions of 4.19% over 12 months, equating to an efficiency saving of > £600,000

16. Pioneer and Pioneer Associate Sites NHS TeesNHS Gateshead NE Lincolnshire Care Trust Plus / NHS North Lincolnshire / North Lincolnshire & Goole Hospitals NHS Foundation Trust South Cheshire and Vale Royal GP Commissioning Consortiums NHS Central Lancashire NHS Liverpool NHS Manchester NHS Northamptonshire NHS Stoke on Trent and NHS North Staffordshire NHS Cambridgeshire NHS Luton NHS North Essex NHS Devon Central London Healthcare Partnership Newham Health Partnership / Newham Commissioning Group NHS Oxfordshire NHS Southampton NHS Brighton and Hove KEYPioneer site live Pioneer site scheduled to go live by Oct 2011 Pioneer associate site livePioneer associate site scheduled to go live by Oct 2011

17. Local innovations Risk profiling/stratification – incorporated in NHS Devon and NHS Brighton and Hove dashboards. Advanced predictive risk modelling data flags up patients at higher risk of further admissions, joining up information relevant to urgent care and long-term conditions work. Urgent care attendances by time – NHS Tees displays attendances at urgent care settings by two-hour time bands, showing demand levels and also potentially picking up inappropriate attendances. Variance – NHS Devon highlights practice activity levels compared to their consortia average and variance over time.

18. Pioneer developments: NHS Devon

19. A&E attendances over time – narrowing the range

20. Dashboard-enabled change

21. Promoting good variation: minimising bad

22. Promoting good variation: minimising bad

23. Promoting good variation: minimising bad

24. System gearing 95% of urgent care is accessed in primary care with 5% in secondary care As a result a 1% increase in primary care causes a 20% decrease in secondary care Dr Jay Banerjee, University Hospital of Leicester