| Emergency
Care Leads Bulletin
This month’s contents:
1. GPs with a special
interest in emergency care
2. Improving the patient experience
masterclass
3. Patient Environment Action Team
review of A&E departments
4. Emergency primary care access service
improves waiting and journey times for patients
5. Emergency services
collaborative update
6. Emergency care
leads toolkit update
7. Emergency care discussion forum
8. How can we improve
this bulletin?
9. Contact Sir George
Alberti
1. GPs with a special interest in emergency care
New guidelines for GPs with special interests (GPwSI) in clinical specialties,
including emergency care, has been published by the Department of Health
to help develop secondary care services in primary care settings.
The guidelines include a framework for GPs with a special interest in
emergency and unscheduled care, developed by the Royal College of GPs
with guidance from the National GPwSI Development Group of stakeholders,
chaired by the national clinical director of primary care Dr. David Colin-Thomé.
All guidance is available at
www.doh.gov.uk/pricare/gp-specialinterests/emergencycare.pdf
A wide range of detailed information for PCTs on the expansion of primary
care services, including A Step-by-Step Guide to setting up a General
Practitioner with a Special Interest (GPwSI) service can be found at www.gpwsi.org/subindex.shtml
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2. Patient experience masterclass
The NHS Modernisation Agency's performance improvement team hosted a patient
experience masterclass on the 30 April. It was designed to give practical
examples to NHS trusts about how to design services that put patients
at the centre. Practical ideas and examples were given to delegates about
improving the patient environment, providing patients with better information,
building relationships with staff and providing children's facilities
in A&E.
Health minister David Lammy gave a keynote address
and the department's patient experience director Harry Cayton spoke about
designing services and making improvements to the patient's experience
of A&E.
Tim Jennings from MORI spoke about research carried
out with patients, where patients highlighted what they wanted to see
improved in A&E departments. Workshop sessions looked at a number of scenarios
and considered how different actions on the part of staff could have improved
the experience of the patient.
There was a good cross-section of NHS staff and patient
representatives, which ensured a lot of good practice could be shared.
For more information contact amy.hunter@doh.gsi.gov.uk
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3. Patient Environment Action Team review of A&E
departments
Patient Environment Action Teams (PEAT) are to undertake a review of all
major A&E departments this summer. This is as a pre-cursor to the inclusion
of A&E departments in future PEAT inspections.
Building on the success of the existing programme introduced in hospitals
in 2000 the teams will assess a range of factors including standards of
maintenance, décor, furnishings and cleanliness to help bring about improvements
to the patient environment in A&E.
The PEAT assessment will be tailored to the specific needs of A&E departments,
using the advice of staff as well as patients and other service industries.
Inspection teams will receive training and will include people with experience
of working in A&E.
Anyone wishing to assist in delivering this important programme should
register with NHS Estates as soon as possible. Participating in PEAT inspections
is valuable and worthwhile and is seen by those already involved as a
unique opportunity to learn from others and share best practice. The improvements
brought about through this process are not only for patients, but also
contribute to an improved working environment for staff.
For more information or to discuss what volunteering involves, contact
Graham Jacob on 0113 237 6509, or e-mail Graham.Jacob@nhsestates.gov.uk
More general information about the Clean Hospitals/PEAT programme can
be found at www.cleanhospitals.com
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4. Emergency primary care access service improves
waiting and journey times for patients
'Hammersmith & Fulham PCT in partnership with
Hammersmith Hospitals NHS Trust have drastically improved patient waiting
and journey times by adopting a whole systems approach to improving emergency
care for patients. The A&E department and the NHS walk-in centre, working
together, have implemented an emergency primary care access service (EPCAS).
The EPCAS is nurse led with multidisciplinary support from both primary
and secondary care physicians, A&E doctors and therapists. This combination
of primary and secondary care services for patients means that those presenting
at the A&E department for care, treatment and advice of a primary care
nature can be discharged and may return home.
In December 2002, a 'see and treat' scheme was piloted at Charing Cross,
the evaluation demonstrated that the average patient journey time in EPCAS
was 49 minutes. It found 75 per cent of the patients were seen and discharged
in less than one hour and EPCAS treated between 55 per cent to 60 per
cent of all A&E patients. From January 2003 the service has been permanently
operating a see and treat model with pre-assessment of patients and a
dedicated A&E doctor available at night and a nurse practitioner at the
weekends.
This has improved waiting and patient journey times, as well as the interface
between primary and secondary care. It has also had a significant impact
on the four-hour waiting time target within the A&E department for non
majors patients, with breaches of the four-hour wait reduced from 45 per
cent to three per cent.
For more information contact Helen Davies on 0207 9431333 or e-mail helen.davies@whitechapel-wic.nhs.uk
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5. Emergency services collaborative update
In its fourth month, sites working with
the collaborative continue to exhibit early signs of sustainable success,
as an average of more than 87 per cent of patients seen by wave 1 sites
have been treated, discharged or admitted within four hours.
Performance has been strong both before and after the end-March interim
target. Over the past five weeks, an average of more than 90 per cent
of trusts in wave 1 have achieved greater than 80 per cent of patients
being seen, treated, admitted or discharged within four hours.
During April, subsequent waves began taking significant steps toward reaping
similar benefits from their work with the collaborative. Waves 2 and 3
held their first two-day learning workshops, at which participants detailed
the changes made to current working practise via presentations and storyboards
and discussed with each other the benefits of and lessons learned from
these changes.
All wave 2 and 3 sites are finalising their site-specific measures, for
better future comparison against baseline data. All sites have in place
dedicated clinical leads and programme managers and are ready to embark
on the next stage of the programme - testing small cycles of change and
completing the seven-day PDSA challenge.
Wave 4 was launched mid-month amid strong attendance and enthusiasm. Sites
in this wave now have completed the programme and project-planning phase
and are moving onto diagnostic work ahead of their first learning workshop
in June.
Representatives from all wave 5 sites have registered for the Information
Day in May, with 92 per cent of those invited agreeing to attend. Sites
are being encouraged to recruit early and fill the programme manager positions,
which are key to making the most of the 14-month programme.
Preparation for wave 6's Information Day in July continues, with sites
actively in the pre-planning phase. Site visits continue as the wave lead
and programme managers familiarise participants with the collaborative's
goals and timeline of events and help sites to plan local teams.
For further information on the collaborative, its
events and the national report, contact Kerrin Howard at 020 7972 1129
or e-mail Kerrin.Howard@doh.gsi.gov.uk
or visit our web site at: www.modern.nhs.uk/emergency
Information on other NHS Modernisation Agency improvement
programmes is also available at: www.modern.nhs.uk
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6.. Emergency care leads toolkit update
The emergency care leads toolkit has been updated. Log
onto http://www.nelh-ec.warwick.ac.uk/ECL_Toolkit/updates.htm
It now includes:
- Whole system changes and networks
- Clinical pathways
- Rapid reviews
- Improving drug prescription and supply
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7. Emergency care discussion forum
The web-based discussion forum for ECLs and others involved in emergency
care networks is up and running now. You can find it at www.info.doh.gov.uk/doh/emergencycareforum.nsf
You'll need a password to gain full access the site. This can be found
in the ECL Bulletin May email alert which is sent to all ECLs from the
Department of Health.
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8. How can we improve this bulletin?
We want to improve communications with staff working throughout emergency
care. As part of that we want to improve this bulletin. What information
do you need? What do you want to tell us? Do you pass the information
on? If you or your team have any ideas or suggestions about how we can
make this better please e-mail rachel.morris@doh.gsi.gov.uk
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9. Contact Sir George Alberti
Remember that Sir George Alberti, the national clinical director for emergency
access, wants to hear the views of frontline staff. Please send your views
to MB-GeorgeAlberti@doh.gov.uk.
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