BMJ 2014;349:g4654 doi: 10.1136/bmj.g4654 (Published 16 July 2014)
Page 1 of 1
News
NEWS All emergency departments should include GP staff, say experts Gareth Iacobucci The BMJ
All hospital emergency departments in the United Kingdom should include a primary care out-of-hours facility to help ease the ongoing pressure on the system, experts have recommended. The recommendation is one of 13 in a joint report from the College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians, and Royal College of Surgeons that outlines solutions for tackling major challenges, including rising activity levels, crowding, and patient flow in emergency departments and staffing levels.1 The report said that co-locating emergency departments with out-of-hours primary care would enable patients to be streamed more appropriately after triage and would foster more collaboration, such as sharing diagnostic facilities. Produced after a joint summit of the four organisations on 4 March, the report said that pressure could also be eased by bolstering the availability of senior staff at times of peak activity and rotating all trainee doctors on acute specialty programmes through the emergency department, to ensure that departments could cope with demand. It also advised that senior clinicians be located at the front door of emergency departments and in surgical, medical, and paediatric units to ensure that patients were seen in the correct setting as quickly as possible.
The report said that emergency departments should not be considered “everyone’s default” option, adding that more effort should be made to coordinate and deliver community and social care seven days a week to support urgent and emergency services. It recommended co-locating community teams in emergency departments to help “bridge the gap” between hospitals and primary and social care. Telephone advice services such as NHS 111 in England could also help reduce the pressure on emergency departments—but only if they were “configured properly with significant clinical involvement and advice,” the colleges added. IT infrastructure must also be improved to ensure that information was integrated and readily accessible across all emergency departments and acute admissions units, the report said.
It added that current funding and targets for emergency department attendances and acute admissions should be changed to support “clinically relevant outcomes.” It said that the current target for patients to be seen in four hours, although useful, has “insufficient drivers in place to eliminate exit block and has perverse effects.” Clifford Mann, president of the College of Emergency Medicine, said it was vital that all steps were taken urgently to “avoid an annual crisis and build a resilient system.” He added, “No plans for acute and emergency care should be developed without reference to these consensus recommendations. The time for action is now.”
Stephanie Smith, of the Royal College of Paediatrics and Child Health, said, “We already know that 25% of all admissions to emergency departments are children and young people, and we estimate that up to 16% of these could have their care effectively managed outside the hospital setting—a significant number that, if addressed, would reduce pressure on units.
“What we need to do now . . . is have better access to out-of-hours primary care, provide doctors with appropriate training and access to advice from paediatricians, and have more effective and consistent advice and information sharing between healthcare professionals to reduce unnecessary admissions.” Richard Thompson, president of the Royal College of Physicians, said, “Over the past few years, services for ill patients have been stretched by the sheer amount of acute and emergency admissions, and we have to plan better for the future to protect patient safety. These 13 recommendations are practical, evidence based, and produced by doctors who care for patients daily. If we do not implement them we shall simply walk blindfolded into another winter crisis.” 1
College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons. Acute and emergency care: prescribing the remedy. 16 Jul 2014. https://secure.collemergencymed.ac.uk/Shop-Floor/Policy/ Acute%20and%20emergency%20care%20-%20prescribing%20the%20remedy.
Cite this as: BMJ 2014;349:g4654 © BMJ Publishing Group Ltd 2014
Copyright of BMJ: British Medical Journal is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Page 1 of 1
News
NEWS All emergency departments should include GP staff, say experts Gareth Iacobucci The BMJ
All hospital emergency departments in the United Kingdom should include a primary care out-of-hours facility to help ease the ongoing pressure on the system, experts have recommended. The recommendation is one of 13 in a joint report from the College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians, and Royal College of Surgeons that outlines solutions for tackling major challenges, including rising activity levels, crowding, and patient flow in emergency departments and staffing levels.1 The report said that co-locating emergency departments with out-of-hours primary care would enable patients to be streamed more appropriately after triage and would foster more collaboration, such as sharing diagnostic facilities. Produced after a joint summit of the four organisations on 4 March, the report said that pressure could also be eased by bolstering the availability of senior staff at times of peak activity and rotating all trainee doctors on acute specialty programmes through the emergency department, to ensure that departments could cope with demand. It also advised that senior clinicians be located at the front door of emergency departments and in surgical, medical, and paediatric units to ensure that patients were seen in the correct setting as quickly as possible.
The report said that emergency departments should not be considered “everyone’s default” option, adding that more effort should be made to coordinate and deliver community and social care seven days a week to support urgent and emergency services. It recommended co-locating community teams in emergency departments to help “bridge the gap” between hospitals and primary and social care. Telephone advice services such as NHS 111 in England could also help reduce the pressure on emergency departments—but only if they were “configured properly with significant clinical involvement and advice,” the colleges added. IT infrastructure must also be improved to ensure that information was integrated and readily accessible across all emergency departments and acute admissions units, the report said.
It added that current funding and targets for emergency department attendances and acute admissions should be changed to support “clinically relevant outcomes.” It said that the current target for patients to be seen in four hours, although useful, has “insufficient drivers in place to eliminate exit block and has perverse effects.” Clifford Mann, president of the College of Emergency Medicine, said it was vital that all steps were taken urgently to “avoid an annual crisis and build a resilient system.” He added, “No plans for acute and emergency care should be developed without reference to these consensus recommendations. The time for action is now.”
Stephanie Smith, of the Royal College of Paediatrics and Child Health, said, “We already know that 25% of all admissions to emergency departments are children and young people, and we estimate that up to 16% of these could have their care effectively managed outside the hospital setting—a significant number that, if addressed, would reduce pressure on units.
“What we need to do now . . . is have better access to out-of-hours primary care, provide doctors with appropriate training and access to advice from paediatricians, and have more effective and consistent advice and information sharing between healthcare professionals to reduce unnecessary admissions.” Richard Thompson, president of the Royal College of Physicians, said, “Over the past few years, services for ill patients have been stretched by the sheer amount of acute and emergency admissions, and we have to plan better for the future to protect patient safety. These 13 recommendations are practical, evidence based, and produced by doctors who care for patients daily. If we do not implement them we shall simply walk blindfolded into another winter crisis.” 1
College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons. Acute and emergency care: prescribing the remedy. 16 Jul 2014. https://secure.collemergencymed.ac.uk/Shop-Floor/Policy/ Acute%20and%20emergency%20care%20-%20prescribing%20the%20remedy.
Cite this as: BMJ 2014;349:g4654 © BMJ Publishing Group Ltd 2014
Copyright of BMJ: British Medical Journal is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
