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Emergency Care Bulletin
Your feedback on improved performance Thank you to all the emergency care staff who responded to our request in the April bulletin for information on how you achieved the 90 per cent milestone in March. We have passed this information on to the Emergency Services Collaborative to help share best practice throughout the country. There was a real mix between quick fixes and long-term improvements. We have set out briefly some of the information you gave us below. Some trusts stated that supportive and actively engaged senior management, who empower A&E teams, helped to bring about real improvements. Others stated that success was achieved because the target was seen as a whole-system target and not just one for A&E. Therefore, the whole emergency care network was involved in the what, why and how things needed to be improved. The support from the Department of Health, the NHS Modernisation Agency and strategic health authorities was also seen as central to bringing about improvements. The dissemination and application of the checklist was perceived to be particularly useful. Many trusts implemented new projects, for example, the re-design of bed management systems, the introduction of a bar-coding system to track patients and pharmacists being based in A&E departments. Training in wound assessment and management was carried out to speed up suturing times. Other trusts used the measurement week, and the run up to it, to pilot new ways of working. For example, one trust tasked four-hour ‘guardians’ to co-ordinate patients through the system, another employed ‘Path Pals’. These were people recently trained to process laboratory samples. They then waited for the results before taking them back to the A&E department, reducing the normal three-four hour wait to 20 minutes after the samples were taken. The feedback was also full of suggestions of work that can be taken forward in the future. This included the development of staff roles, for example, having autonomous nurse practitioners that care for patients before a decision is made to admit them, training staff in Patient Group Directives and training for senior team members as emergency nurse practitioners. To find out more about these examples or to contact the trusts who initiated the projects please contact the Modernisation Agency's Emergency Services Collaborative on 020 7061 6777 or e-mail kerrin.howard@doh.gsi.gov.uk This month Rosie Winterton, the newly-appointed health minister, would like to introduce herself as she takes up the baton to drive forward improvements in emergency care. "First, I would like to stress how pleased I am to be taking on one of the Government’s top priorities – emergency care. This area of work is just as important to me as my predecessor and I hope I can help you to continue to build upon the huge improvements that have already been made. However, you know as well as I do that there is much more work to be done. As the December 2004 target approaches, for all patients to be in and out of A&E within four hours, the efforts and excellent work that has brought us this far must continue to make sure improvements are sustained for the benefit of patients and staff alike. I want to know what help we can offer you to ensure we all achieve real success and bring about real improvements to the entire patient experience in emergency care. I know what a crucial role you all play in driving forward improvements, I am therefore especially keen to hear your views and I am looking forward to working together to overcome the challenges ahead." Rosie Winterton Please send your feedback for the minister to emergencycare@doh.gsi.gov.uk Bed management Managing beds to match patient flows is critical to delivering NHS Plan targets for both emergency and elective care, and is central to the department's plan for reforming emergency care and ensuring that elective operations take place as planned. As bed management is so complex and the range of possible improvements must be tailored to reflect local needs, the NHS Modernisation Agency's Emergency Services Collaborative (ESC) has developed a five-module bed management improvement programme. The ESC will disseminate the programme via their wave-specific learning workshops and one-day events. Individual trust representation will be co-ordinated through site programme managers and the timescales will ensure that all sites have the opportunity to access all modules and undertake the necessary improvement work before the four-hour target date for each wave. Participation is completely voluntary and, after the first diagnostic module, sites can choose which modules will help them most. To support local implementation of the programme a Train the Trainer Programme for relevant strategic health authority staff has been scheduled. For further information contact Elizabeth Bradbury by e-mail at elizabeth.bradbury@doh.gsi.gov.uk or telephone 020 7061 6777 Information on the Emergency Services Collaborative is available at www.modern.nhs.uk/emergency and on other Modernisation Agency improvement programmes at www.modern.nhs.uk Ambulance improvement checklist The Department of Health has produced a checklist to help ambulance trusts improve and streamline the care of patients. The checklist focuses on actions that ambulance trusts can take to improve patient care but it also recognises the role that other parts of the NHS can play including other parts of emergency care, primary care and social care. The checklist stresses the need to focus on services from the patient’s perspective and the need to make sustainable improvements that do not negatively impact on other parts of the patient’s journey. The toolkit is available from www.doh.gov.uk/emergencycare/amb-checklist.doc For more information and to provide feedback on the checklist contact Daniel Scheffer on 020 7210 5126 or e-mail dscheffe@doh.gsi.gov.uk The Department of Health is publishing a review of the coronary heart disease National Service Framework thrombolysis targets. This is to support better care for patients suffering from acute heart attacks and delivery of the 60-minute call-to-needle time thrombolysis target set for 2006. The document:
The review is at www.doh.gov.uk/heart/thrombolysis/review Audit of care following a heart attack The second report of an audit on the care of patients who have been taken to hospital in England following a heart attack was published by the Royal College of Physicians (RCP) on 18 June. The results in this second MINAP (Myocardial Infarction National Audit Project) report cover the period 2002-2003 and show consistent and sustained national improvement quarter on quarter. The full results are at www.rcplondon.ac.uk Patient information in A&E departments Research carried out by the department last year identified that patients want to receive better information in A&E departments. Patients want to know more about what will happen to them, their treatment and how the A&E department works, as well as about how long they may have to wait and why. To help trusts locally, and as part of the on-going programme of work to improve the patient experience in A&E departments, we are looking to produce a What will happen to me in A&E? leaflet for patients. This would take the form of a template for strategic health authorities so they can be tailored with local information for patients. We are keen to produce one for adults and then a separate one for children, which would be both informative and fun, possibly incorporating games or pictures to colour in. We know that some trusts have already produced excellent leaflets and we want to build on this to produce a national template. We would be keen to see examples and to hear about any evaluation of what has worked and what hasn’t. If you or members of your teams have any ideas or suggestions, please let us know by e-mailing clare.allcock@doh.gsi.gov.uk or telephone 020 7210 5161. On 16 June the Department of Health wrote to strategic health authorities confirming the performance management and rating position for the A&E waiting time target in 2003-2004. All trusts and PCTs that provide A&E services should make sure that at least 90 per cent of patients visiting A&E (including type 2 and 3 services like walk-in centres) are admitted, transferred or discharged within four hours of arrival. Performance will be measured as a monthly average. For star ratings purposes it will be measured across the last nine months of the year (i.e. 1 July 2003 – 31 March 2004). Trusts will also be expected to reach the 100 per cent target within a few months of completing their participation in the Emergency Services Collaborative, although that will not affect star ratings in 2003-2004. The Department of Health and the professions are discussing a joint position on clinical exceptions to the 100 per cent target. For more information contact your strategic health authority. Pilot schemes to implement the new pay reforms are to get underway. This follows agreement on the Agenda for Change pay system between UK health departments, health service employers and unions. Several ballots have taken place which showed strong support for testing the new structures prior to full implementation of the reforms across the NHS. Agenda for Change will sweep away local pay differentials and harmonise conditions of service, as well as provide clearer links between pay and career progression using the NHS Knowledge and Skills Framework as a basis. Twelve sites have been chosen to test the new systems. Agenda for Change will also apply to the first wave of NHS foundation trusts. More at www.doh.gov.uk/agendaforchange The genetics White Paper, Our inheritance, our future – realising the potential of genetics in the NHS, was launched on 24 June 2003. It sets out a comprehensive plan that will help the NHS prepare the ground so that patients can benefit from future advances in genetics. The White Paper and executive summary are available at www.doh.gov.uk/genetics/whitepaper.htm Recent additions to the electronic library and toolkit A summary of recent additions to the National Electronic Library for Health’s emergency care specialist library is available at www.nelh-ec.warwick.ac.uk/ and recent additions to the emergency care toolkit are available at www.nelh-ec.warwick.ac.uk/ECL_Toolkit/index.html New clinical negligence system A new system for handling cases of clinical negligence in the NHS has been proposed by the Government’s chief medical officer. In his report Making Amends, Sir Liam Donaldson recommends the creation of a new NHS Redress Scheme to speed up the process. Under the proposals, the redress scheme will be initially applied to NHS hospitals and, if successful, the Department of Health will consider extending it to primary care. A consultation period will now run until October after which a definitive statement of policy will be issued. The full report is at www.doh.gov.uk/makingamends Emergency care discussion forum Log onto the web-based discussion forum for people working in emergency care and associated networks at www.info.doh.gov.uk/doh/emergencycareforum.nsf The password is included in the e-mail alert or is available from your emergency care lead. Ambex Conference – 27-29 June A three-day conference for ambulance services was held in Harrogate. The director of emergency care Sir George Alberti was one of the main speakers. A summary of his speech will shortly be available on www.doh.gov.uk/conferences
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