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Emergency Care Bulletin
Patient Group Direction templates published Patients needing emergency treatment will get speedier care as the Department has published 18 new national Patient Group Directions (PGDs). These explain clearly to nurses, paramedics, physiotherapists and pharmacists how they can make more use of extended powers that were given to them in 2000. A further 12-15 templates are under development and will be added to the website over the next few months. These will include templates for thrombolysis, diamorphine, oxygen and others. Health Minister Rosie Winterton said: "Patients often need medicine as a part of their treatment but many have to wait to be seen by a doctor so that a prescription can be written for the medication. Patient Group Directions enable patients to receive the medications they need without a prescription from a doctor. They allow appropriately trained and competent healthcare staff to supply and administer specific medications without the need for a prescription from a doctor." Mary Dawood, nurse consultant in A&E at St Mary's Hospital, London said: "The publication of these PGDs is a positive and progressive step towards uniformity in practice. Their development will greatly assist nurses who have to embark upon the bureaucratic and often convoluted process that has been synonymous with the formulation of these essential documents. Their development at a more central level endorses the process and will empower nurses where they encounter resistance." The templates are available at www.nelh.nhs.uk/emergency For more information or to send feedback e-mail emergencycare@doh.gsi.gov.uk The Department of Health and the NHS Modernisation Agency have published a report to illustrate the success of critical care outreach services in the management of critically-ill patients. The document Critical Care Outreach 2003 - Progress in Developing Services provides examples of ways in which outreach is improving patient care, reducing pressures on critical care units and increasing staff skills and knowledge. It is intended for multi-professional use and can be used to inform the operational and business planning of services. It does not, however, place any additional burdens or requirements upon the NHS but focuses on examples of successful practice and benefits that have been achieved. Royal College of Nursing general secretary Dr Beverly Malone said "Like the Government we would like to see critical care outreach services in all hospitals. This document reveals that the introduction of critical care outreach services is providing a positive effect on patient care. But, for this to become a reality throughout the UK, it’s crucial that dedicated funding is provided. Many of these complex services are nurse-led so it’s vital that nurses are given appropriate prescribing rights. This will ensure prompt and timely intervention and make use of all available expertise." The report is at www.doh.gov.uk/emergencycare/oct03_critcare.pdf For more information e-mail paulette.clarke@doh.gsi.gov.uk or call 020 7633 4046 Implementing the GMS contract: out-of-hours Practical support on key steps for implementing out-of-hours (OOH) services has been published. The Department of Health paper aims to help strategic health authorities (SHAs) and primary care trusts (PCTs) deliver OOHs, which come into effect next April. This is the first of a series of papers being developed to help staff and organisations deliver sustainable, integrated and high-quality OOH services. Other papers will cover provider development, funding, performance management and understanding the OOH elements of the GMS contract regulatory framework. The paper outlines the issues that commissioners and providers of local OOH services need to consider to meet the challenge of providing high quality OOH care. It draws on the experience of national pilot sites and also suggests the systems that need to be set up to deliver this service. National clinical access and choice lead Dr David Carson said: "The challenge for local health communities will be to establish new provider partnerships building on the strengths of all providers including GP OOH providers, co-operatives and commercial providers, community services, NHS Direct, ambulance services and acute trusts. "Everyone’s expertise and capacity is likely to be required in each area to ensure sustainable services which facilitate GPs to opt out of their OOH responsibility, where they wish to do so." For further information contact John Taylor on 0113 25 45704 or at John.Taylor@doh.gsi.gov.uk. The paper is at www.out-of-hours.info Redesigning A&E support services – case study NHS Estates and Northumbria University are leading the way in improving support services in A&E departments through changing clinical practice and modernising the physical environment. It has been possible to identify and design the most appropriate support job specifications to ensure the A&E department is clean, safe and reassuring at all times. Project lead Neil Thompson said: "During the pilots, we found that processes to deliver support services in A&E departments were often fragmented and inconsistent. Role responsibility was often unclear, with nurses spending time on tasks others could do. We developed a workbook that we hope other trusts will use to help provide support services that reflect new, more efficient clinical pathways. The workbook will be rolled out nationally with the NHS Modernisation Agency as part of the Emergency Services Collaborative (ESC), and findings will be presented at the first learning workshop of each wave of the ESC." Following involvement in the pilot, Hull Royal Infirmary employed its first housekeeper in A&E, Karen Marshall. Senior A&E charge nurse Helen Hudson said: "We all identified the need for a housekeeping role within A&E. Previously up to 20 per cent of our time was taken up doing non-clinical work. Since Karen’s arrival, I have seen a vast improvement in the way our department is presented. She also plays a key role in communicating with patients and motivating staff. Asked how I ever managed without her, I do not know. I have already recommended the role to many areas that don't already have it." For more information contact Neil Thompson on 0113 254 7209 or neil.thompson@doh.gsi.gov.uk Supporting Patient Care in Accident & Emergency – Redesigning Housekeeping and Support Services is at http://www.nhsestates.gov.uk/download/publications_guidance/A&Eredesigndoc.pdf This month Central Manchester and Manchester Children’s University Hospitals NHS Trust chief executive Mike Deegan talks about his role as chair of the Emergency Care Task Group set up to look at new ways to expand choice, responsiveness and equity in the NHS "The main aims of this national consultation are to improve patient and user experience and build new partnerships between those who use health and social care and those who work in them. It is a wonderful opportunity to ensure we understand and meet the real personal needs of patients and users, especially those who traditionally have had difficulty accessing emergency care. "The concept of choice in emergency care is a fairly new one, so input to the consultation from patients, service users, voluntary groups and health and social care workers is a real chance to help shape services in the future. "The Emergency Care Task Group is made up of patient representatives alongside NHS professionals. It also includes the national director for emergency access, Sir George Alberti and the newly-appointed clinical director for patient experience in A&E, Jonathan Asbridge. The group is about to embark on a series of engagement sessions with service users across the country to ensure the ideas we have formulated so far fit in with their thinking. We are keen to hear what you think." If you want to get involved, full details of the consultation, including information on how to make contributions, are available at www.doh.gov.uk/choiceconsultation If you would like to feedback to Mike you can contact him on 0161 276 1234 or via michelle.green@cmmc.nhs.uk Emergency Care Conference The Emergency Care Conference 2003 is to be held on 2 December at The Congress Centre, 28 Great Russell Street, London WC1. It will provide a fantastic opportunity for all those involved in the field to hear from key speakers, participate in workshops and learn from current best practice. For further information contact Susannah Nelson on 020 7633 4044 or e-mail susannah.nelson@doh.gsi.gov.uk
Live or Let Die campaign encourages people to learn CPR The London Ambulance Service NHS Trust launched the campaign Live or Let Die on 7 October offering free CPR (cardio-pulmonary resuscitation) training to the public. This simple, life-saving procedure can double the chances of survival when someone is in cardiac arrest. Most cardiac arrests happen in the home but too few people have the skills to save a life. Live or Let Die will raise public awareness about heart attacks and cardiac arrests with a London-wide poster campaign and aims to improve survival rates in the capital. Health minister Rosie Winterton, who has responsibility for emergency care, said: "We welcome the London Ambulance Service's campaign. Providing training in the community and helping to promote public involvement and awareness can help save crucial seconds before the ambulance crew arrives at the scene." For further information contact Claire Brunert on 020 7463 2517 or e-mail claire.brunert@lond-amb.sthames.nhs.uk Emergency services collaborative update More than 10.8 million people have received care at A&E departments in less than four hours across England over the past 12 months, compared to 8.6 million people the year before. That means that an extra 2.2 million A&E patients benefited from innovations and changes made during the Emergency Services Collaborative programme (Figure 1).
Figure 1
Individually, waves are showing incremental, sustained progress. More than 90 per cent of Wave 1 patients on average were seen, treated, admitted or discharged within four hours as of mid-September 2003, compared to 83.4 per cent in 2002. Overall performance of Wave 1 has been at or above 90 per cent since late March, suggesting that improvements made thus far are sustainable, long-term changes. Wave 2 achieved 89.3 per cent as of mid-September 2003, up from 72.4 per cent in 2002. Wave 3 achieved 88.7 per cent this year, up from 75.45 per cent last year. Wave 4 achieved 91.6 per cent this year, up from 80.39 per cent last year. The majority of A&E departments in England are achieving between 85 per cent and 95 per cent of patients being seen, treated, admitted or discharged within 4 hours. This is in stark contrast to last year, in which performance was distributed more broadly and the variation in patient journey times was greater. For further information on the ESC, its events and monthly report, contact Kerrin Howard at 020 7061 6780; e-mail Kerrin.Howard@doh.gsi.gov.uk or visit the website at www.modern.nhs.uk/emergency The National Service Framework for Children, Young People and Maternity Services – Emerging Findings report was published for consultation in April this year. The consultation period ended in August and 113 replies from a wide range of organisations and individuals were received. Overall the responses supported the proposals but stressed that significant challenges lie ahead. The Children's NSF team is grateful to all those who responded and will now consider the responses as part of the development of the overall NSF. Emerging Findings and a full summary of responses is available at www.doh.gov.uk/nsf/children Recent additions to the electronic library and toolkit A new page of information about A&E and emergency
care available at
The national template for emergency care Patient Group
Directions is at www.nelh-ec.warwick.ac.uk/ECL_Toolkit/PGDs.htm
7-9 November 2003 – Royal College of Nursing A&E Associations 31st Annual Conference and Exhibition, De Vere Daresbury Park Hotel, Daresbury, Cheshire 2 December 2003 – Emergency Care Leads Conference, The Congress Centre, 28 Great Russell Street, London WC1
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