khurshid alam and nuh
Post on 13-Jul-2015
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Khurshid Alam
FCEM, MRCS, MSc and MBBS
Opportunities for redesigning Emergency Care Pathways at NUH?
Objective:-
1. What are the elements exerting pressure on NUH Emergency Dept.
2. What are at present and what will be the demands on Emergency
care services in future?
3. How to transform the existing Emergency Care Services to fulfil
future demands?
4. Summary and Conclusion.
pressure on NUH
Emergency Dept
Elements exerting pressure on NUH Emergency Dept
Performance Measures
Funding Shortage
Staffing Pressures
Increased Activity
Fragmented Primary and Secondary
Care
Poor Flow of Patient Data
http://www.foundationtrustnetwork.org/resource-library/emergency-care-and-emergency-services-2013/ +Personal Views.
Fragmented Primary and Secondary
Care
Increased Activity
• 3% rise in annual attendance nationally
• Growth in chronic diseases
• Frail elderly
http://cms.nottinghamshire.gov.uk/jsna-chapter2.pdf
Staffing pressures
• Recruitment of Middle grades
• Senior cover on shop floor
• Reliance on bank and locum staff
Consultant 18.7/27
Middle Grade 5/9
Locums MG 5-6/day
http://www.england.nhs.uk/2013/11/13/keogh-urgent-emergency
Performance Measures
• 4 Hours target
• Clinical Quality Indicators
• Friends and Family Test
NUH ED Weekly Report
Wednesday 15th to Tuesday 21st Jan 2014
4 hour target of 95% was not achieved by ED
on any day
4 HOUR TARGET
PERFORMANCE ED
Eye
Casualty
Combined
A&E
REPORTING WEEK 90.73% 99.73% 91.74%
FY to end reporting week 93.26% 99.86% 94.00%
A Picture of Fragmented EHCS and Society's Unawareness
3-Painful Cough- Pharmacy
4-Painful Stomach-
GP
2-Uncertain /confused –call NHS111
1-Sore Throat Self Care
5-Minor Illness and Injury- Walk in Centre
6-Severe Chest Pain- Should be Front of
the Queue
New Health Services and Funding Arrangements
Emer. Admission
Emergency Depts.
Walk In/ Urgent Care
Primary care
Self care
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UH
Dorset Pyramid of Redesigning Emergency Care Services
Single point of access
Self-Care
Emergency Medicine Departs.
Hospitals
Redesigned NUH Emergency Health Services
Walking Patients
Pharmacy NEM Minor Injury
Acute Mental and Alcohol
Services
FACT Team
Resus Major Area
RAT Paed. A&E
Stream Lining Co-ordinator
RADIOLOGY
Social Services
GPs
Opportunities for NUH after Redesigned Acute Emergency Services(AMS)
1-This particular redesigned of NUH-AMS will bring under one roof , Primary care, Social Services and Community Services working along with NUH. 2-Patients will receive AMS based on their health needs, utilization effectively and efficiently of AMS, reducing waste and duplication of efforts. Thus addressing the issue of reduced Funding. 3-Co-ordinated flow of patient, increasing the satisfaction and experience of patients. 4- NUH and Others Organizations should develop the co-ordinated pathways of Common conditions. 5-NUH should develop and train its permanent workforce, Increasing ANP, ENP, Non-Deanery training AE fellows, speciality consultant working in A&E addressing Staff Shortage. 6-This redesigned model will help NUH to achieve national targets, Foundation Status and would be help to be England's Best Acute Teaching Hospital by 2016.
Summary and Conclusion
1-Redesinging the Mould rather than Base of The Whole Emergency Care Services. 2-Adopting a Uniform Triage Systems by NHS Direct or 111 NHS , Based on EBM and Involvement of all stakeholders. 3-Clarity of extent of functions of each component of Emergency Care Services to relieve the confusion among Patients and Health Care Providers. 4-Desiging functioning pathways, respected and adopted by whole Emergency Care Services 5-Adopting a Uniform Monitoring system across all the components of Emergency Care System . 6- Affective Net-working among all the component for rapid communication and avoiding duplication.
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