Announced in 2010, implemented from April 2011.
- Ambulatory Care
Initially focused on
Cellulitis
Deep vein thrombosis
Both these conditions had >60% potential to avoid admission if used appropriately
Review and assess the way we manage these cases and attempt to embed ambulatory care into departmental practice
Achieving
Liaison with medicine if they already have a dedicated ambulatory care area
Correctly classifying the patients who reattend eg for abx for cellulitis
- Unplanned re-attendance
Should be between 1-5%
- Total time spent in the ED
Should be <95%
The single longest wait should be no more than 6 hours – this includes patients waiting for a level 1 bed
- Left without being seen
>5% is an area of risk, patients who leave the ED before the required detailed formal clinical process is completed are known to be at risk of adverse events
- Service experience
will look at – steps which have been taken regularly to assess experience of the ED or UCC
- what has been done to improve services
- Time to initial assessment
Full initial assessment for cases arriving by ambulance – should be within 20 mins of arrival or handover by ambulance crew
- Time to treatment
Should not be >60 mins, median time reported
Rate of missing data should be <5%
***Avoid use of hello clinician who adds little value ***
Should not use junior staff who lack the experience to make definitieve clinical decisions
Avoid excessive front loading
- Consultant sign off
This now includes 4 main groups
Chest pain in >30 yr olds
Febrile illness in <1 yr old
Abdominal pain in adults >70 years old
Unscheduled returns (with the same complaint) within 72 hours
How can we achieve these?