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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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.