Although there have been some successful initiatives to improve how the NHS delivers urgent and emergency care to relieve struggling acute hospital services, more remains to be done. Achieving patient flow is essential for patient experience, clinical safety and reducing the pressure on staff, however, good flow continues to be elusive throughout the patient’s journey.
The NHS long term plan has revealed key ambitions that will look to reduce some of the pressures within hospital settings and help provide timely and appropriate care, in the right settings, which will maintain flow, promote successful outcomes and deliver efficiencies.The 6th Annual Urgent and Emergency Care: Facilitating Patient Flow conference will examine in depth the aims of the long-term plan and how they will impact on urgent and emergency care delivery. Key areas of focus include:
The agenda will provide delegates with a greater understanding of how the long-term plan will shape the future of urgent and emergency care provision and discuss the opportunities and the challenges in providing a sustainable service that is reactive to demand.
In recent years there has been significant measures taken to alleviate some of the pressures within the urgent and emergency care service. The availability of evening and weekend GP appointments, greater access to the NHS 111 service and reductions in delayed transfer of care (DToC) are just some examples of initiatives assisting with providing the right treatments, at the right time, in the right place. If more of this can be achieved, then patient flow can be improved, and better outcomes can be realised.
The acute hospital system can easily become congested by the sheer numbers of those attending the emergency department through to the delays experienced in sending those that medically fit for discharge home.
The NHS Long Term Plan has set out its aims to improve the delivery of emergency and urgent care and release the pressure the system is currently working under. There is to be a boost in primary and community healthcare, with funding worth £3.5 million per year, in real terms, by 2023/24. The hope is that this will provide more urgent care and greater support in the community, as an alternative to hospital.
As part of the NHS 111 provision, multi-disciplinary Clinical Assessment Service (CAS) will be rolled out during 2019/20. The aim is to offer specialist advice, treatment and referral from a wide range of health professionals. Also, by 2020, The Urgent Treatment Model will be fully implemented. These GP led facilities will offer locally accessible and convenient urgent care for patients that do not need to attend hospital. New 24/7 Rapid Response Teams are to be established and will comprise of doctors, nurses, physiotherapists etc. to prevent admission to hospital and aid timely discharge and recovery.
Also, during 2019/20, all major A and E Departments will introduce Same Day Emergency Care (SDEC), also known as ambulatory emergency care. This will involve new diagnostic and treatment practices and allow patients to spend just hours in hospital and avoid being admitted. This will benefit the patient flow by freeing up beds and reduce pressure throughout the rest of the hospital.
The plan also looks to develop new ways of working to improve patient pathways following strokes, heart attacks, major trauma, asthma attacks and sepsis.
Efforts will be made to reduce the number of patients that remain in hospital, despite being medically fit for discharge. These delayed transfers of care snarls up patient flow and increases risk to patients from both physical and cognitive deterioration.
At the Urgent and Emergency Care: Facilitating Patient Flow conference, the plans for urgent and emergency care will be discussed, digested and debated to provide an informed vision for the future.
The urgent and emergency care system continues to be under real pressure, despite recent improvements following the publication of the Five Year Forward View. The Long-Term Plan sets out action to ensure patients get the care they need, fast, to relieve pressure on A&Es and promote patient flow throughout the whole system and expedite timely discharge.
The NHS Long Term Plan is packed with important, timely and exciting service developments and proposals. The challenge for NHS, social care and patient leaders is how to prioritise and implement the content of the plan.
A new law came into effect on 1st April 2018 to allow advanced paramedics in England to prescribe medicines to people who do not need hospital treatment. How has the introduction helped patients and reduced the need for additional healthcare professional input?
Rapid-response teams of GPs, nurses and physiotherapists provide urgent care in the community and help keep patients out of hospital. Under the long-term plan for the NHS, new teams will operate 24/7 and will provide both emergency treatment, as well as support to help patients recover closer to home.
The NHS will fully implement the Urgent Treatment Centre model by autumn 2020, so that all localities have a consistent offer for out-of-hospital urgent care. UTCs work alongside other parts of the urgent care network including primary care, community pharmacists, ambulance and other community-based services to provide a locally accessible and convenient alternative to A&E for patients who do not need to attend hospital.
A Clinical Assessment Service (CAS) is a multidisciplinary intermediate service that allows for a greater level of clinical expertise in assessing a patient.
This expertise should be used to ensure that patients are directed efficiently and effectively into the most appropriate onward care pathway. The service will be embedded within integrated NHS 111, ambulance dispatch and GP out of hours services from 2019/20
During 2019/20 all major A&E departments will introduce same day emergency care (also known as ambulatory emergency care). This will see some patients admitted from A&E undergo diagnosis and treatment in quick succession so that they can be discharged on the same day, rather than staying in hospital overnight. The plan estimates that up to one-third of all people admitted to hospital in an emergency could be discharged on the same day by rolling out this model. This will help ease congestion and patient improve flow.
A new mobile application will help support ambulance staff to ensure suspected stroke patients are taken to the best site as quickly as possible after being developed following Health Innovation Manchester’s “Mobilise the NHS” Scheme.
The app, which has already been tested by North West Ambulance Service (NWAS), presents clinicians with a clear flowchart of buttons to follow to ensure patients suffering from a suspected stroke are taken for specialist care and rapid treatment at a Hyper Acute Stroke Units (HASUs)
In 2016/17 Sheffield had one of the highest numbers of delayed transfer of care days. To revise the existing complex discharge system, they encouraged clinical staff on ward rounds to ask “why not home and why not today?” This is echoed in daily in discharge meetings with the trust, local authority and CCG where they ask that question of every patient who is
delayed. They also have weekly flow meetings to look at the themes for delays and
regular escalation meetings to address problems. They have seen a huge improvement in reported delayed days – down from c. 150 beds full of patients who didn’t need to be there down to c. 70 beds.
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