REFORMING EMERGENCY CARE

St. Jude's

Past, present and future.

Summary

• The workload

• The good news

• The bad news

• The problems

• The solutions.

Workload.

• 67,000 new patients/ year (160-240/day).

• Increase of 4 % over last year.

• 16,000 hospital admissions

• Increase 7% over last year

The good news.

• Stable motivated workforce

• Improving local profile

• 69% of patients discharged/admitted within 4 hours of arrival.

• 96% of patients requiring admission admitted within 4 hours.

The bad news

• Still long waits at nights and weekends, this trend is getting worse

• Waits even for category 3 patients unacceptable at times (department judged unsafe 3 times in last winter)

• Some patients waiting more than 12 hours on trolleys although not 12 hour trolley waits???

Bad news

• Increasing numbers of medical patients diverted to A&E rather than wards due to bed problems

• Thrombolysis figure for the hospital poor (20% only with door to needle times < 30 minutes)

The problems

• Long trolley waits

• Long waits for minor injury

• Poor door to needle times

The solutions - trolley waits

• The solution to this is a matter for the whole hospital or even whole emergency system.

• The roots of the problem lie in under capacity

• Collaborative work with social services/primary care/acute medicine

Solutions - Minor waits

• Process re-design- empowered triage

• Minor illness to GP out of hours service

• Minor injury stream

• Nurse practitioner shifts weekends/ evenings

What we need.

• An end to trolley waits

• An end to trolley waits

• An end to trolley waits

• 4 nurse practitioners

Summary

• A&E problems the cardinal symptom of excess demand and under capacity

• The trolley wait problem needs a whole system approach to improve the situation

• Waits for minor injuries can be improved by re-design and nurse practitioners.