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The EmergencyServicesCollaborative:challenging roles

The Emergency Services Collaborative(ESC) is a national programme ofemergency care reform, established by theNHS Modernisation Agency in responseto the ‘Reforming Emergency Care’documentation and the targets foremergency care identified in The NHSPlan (DoH 1997). The ultimate goal ofthe ESC is to reduce waiting times anddelays, and to improve patients and carersexperiences of emergency care.

The ESC incorporates all acute NHStrusts with Accident & Emergency(A&E) departments within England andWales. The first of six waves waslaunched in October 2002, with eachwave lasting a total of 15 months. TheNewcastle upon Tyne Hospitals NHSTrust joined in the fourth wave in April2003. It is intended that a collaborativeapproach will enable local staff to reviewtheir emergency care services, by re-evaluating the way that care is deliveredand by sharing good practice.

Four groups have been establishedwithin the Newcastle upon TyneHospitals NHS Trust, and these areworking to identify ‘bottlenecks’ in thepatient flow processes and in the provisionof service delivery. In order to support thedevelopment of practice, we need tochallenge traditional roles and ways ofworking.

Within the Newcastle upon TyneHospitals NHS Trust, the role ofemergency nurse practitioner is well

established, with these nurses working todefined protocols within a minor injuriesunit. The role of the emergency nursepractitioner has been developed toinclude children’s nurses to support thehigh proportion of children attendingA&E departments. The role of the paedi-atric nurse practitioner has had a verypositive effect on the care andmanagement of sick children within thedepartment.

The work of the Collaborativerevealed the need to further explore therole of the emergency nurse practitionerto support the care of other patientgroups outside the current minors andpaediatric streams. Examples of suchgroups include those with clinical condi-tions such as asthma, fractured neck offemur and dislocated shoulder.

The Emergency Services Coll-aborative focuses on a whole-systemsapproach to improving patient care andrecognizes that constraints in patient flowmanagement have an adverse effect on thetime patients spend in A&E departments.Ensuring that existing beds becomeavailable earlier in the day will help toalleviate the demand for beds that iscreated artificially by routine dischargestaking place in the late afternoon, at theexact time that demand for these bedsexists because of elective admissions andthe emergency workload.

Several strategies are available tomanage this problem, including the useof discharge lounges, ward day rooms,and pro-active discharge managementsupported by discharge co-ordinatorsand bed managers. Several truststhroughout the national EmergencyServices Collaborative programme haveidentified the benefits of establishing a

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dedicated team to facilitate the timelymovement of patients to optimizeavailable bed capacity. This approachalso benefits ward-based staff, who oftenfeel the pressures created by thecompeting demand for beds, andsupports a philosophy of pro-active bedmanagement. The team approach iscurrently being considered within theNewcastle upon Tyne Hospitals NHS

Trust in order to support the existingpatient f low mechanisms alreadydiscussed.

Martin Hagland and Dot Kyle

Address correspondence to: Martin Hagland, ESCProgramme Manager, Newcastle upon TyneHospitals NHS Trust, Patient ServicesDepartment, Freeman Hospital, High Heaton,Newcastle upon Tyne, UK.

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