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Welcome to the Emergency Care online newsfeed. Here you’ll find all the latest research, news stories, policy updates and guidelines. View our other newsfeeds for more subject-specific news.

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Redesigning urgent and emergency care

The impact of redesigning urgent and emergency care in Northumberland | The Health Foundation

This report considers findings from analysis into the early impact of changes to urgent and emergency care services in Northumberland following the opening of the country’s first bespoke emergency hospital in 2015. It highlights that reconfiguring NHS services takes time to generate the intended results and that robust, repeat evaluation can help to inform decisions and improvement.

Full report: The impact of redesigning urgent and emergency care in Northumberland 

Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?

Urgent and emergency care: best practice

This CQC report offers practical examples of how leading emergency departments are meeting the challenges of managing capacity and demand, and managing risks to patient safety .

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This report from the Care Quality Commission details the good practice identified following the Commission’s work with consultants, clinical leads, senior nursing staff and managers from leading emergency departments in 17 NHS acute trusts.

This resource identifies:

  • strategies staff use to meet the challenge of increased demand and manage risks to patient safety
  • positive actions to address potential safety risks and to manage increased demand better
  • how working with others can manage patient flow and ensure patients get the care they need
  • that rising demand pressures in emergency departments are an issue for the whole hospital and local health economy.

Full report: Sharing best practice from clinical leaders in emergency departments

Addressing ambulance handover delays

NHS England has written to ambulance trusts setting out actions that need to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

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 ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’ sets out the main points from recent guidance documents, and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

There are 4 key principles:

  • The patients in the urgent care pathway who are at highest risk of preventable harm are those for whom a high priority 999 emergency call has been received, but no ambulance resource is available for dispatch.
  • Acute Trusts must always accept handover of patients within 15 minutes of an ambulance arriving at the ED or other urgent admission facility (e.g. medical/surgical assessment units, ambulatory care etc.)
  • Leaving patients waiting in ambulances or in a corridor supervised by ambulance personnel is inappropriate.
  • The patient is the responsibility of the ED from the moment that the ambulance arrives outside the ED department, regardless of the exact location of the patient.

Full document:  ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’

A&E waiting times: £360m needed to meet targets

Winter is coming. How much would it cost to keep the pressure down? | The Health Foundation | Story via OnMedica

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New analysis from the Health Foundation suggests that this winter could see the worst performance against the NHS four-hour A&E target since records began in 2004-5.

The analysis uses projected trends in A&E attendances, the number of people waiting over four hours at A&E, and the number of those needing admission but waiting over four hours for a bed. The projections suggest that around 735,000 people will wait longer than four hours in the last quarter of 2017-18 (January – March), equal to a 311% increase on winter 2010-11.

The NHS aims to admit, discharge, or transfer 95% of people within four hours of arriving at A&E. But in a worsening financial climate, hospitals are now struggling to meet this target all year round, not just in winter.

Full analysis: The Health Foundation:  Winter is coming. How much would it cost to keep the pressure down?

See also: OnMedica:  Millions needed to shore up NHS this winter, says think tank

 

What do the numbers say about emergency readmissions to hospital?

This briefing analyses emergency readmissions data from hospital trusts across England from the past five years. It aims to help hospital trusts’ boards, managers and clinicians identify risk and learn from occasions when things have gone wrong.

Healthwatch has published an analysis of data from hospital trusts examining emergency readmission data from the last five years.

Seventy two hospital trusts responded to the Healthwatch enquiry; their data indicate that emergency readmissions have risen by a fifth since 2012/13:

  • Between 2012/13 – 2016/17 the number of emergency readmissions rose by 22.8%. This compares with a 9.3% rise in overall admissions to hospitals during the same period.
  • The numbers of emergency readmissions within 24 hours rose even faster with a 29.2% increase
  • The number readmitted within 48 hours account for 1 in 5 of the overall total of emergency readmissions (21.6%)

Healthwatch is calling on the NHS to do more to understand why people are returning to hospital after being discharged.

Full story at Healthwatch

Deep Venous Thrombosis in Trauma: Implications for Hospitals and Patients.

The objective of this study was to determine the prevalence of chronic DVT in hospitalized trauma patients | Journal of Trauma and Acute Care Surgery

B0008083 Blood clot in a vein

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC 4.0

Deep venous thrombosis (DVT) is considered a preventable complication in trauma patients. Hospitals risk financial penalties for DVT rates above accepted benchmarks. These penalties do not apply to chronic DVT which develop prior to admission. Lower-extremity duplex ultrasound (LEDUS) can detect characteristics of thrombus chronicity, allowing differentiation of chronic from acute DVT.

LEDUS can identify chronic DVT, which represents nearly 30% of all DVT found on initial screening LEDUS in trauma patients. Those with chronic DVT should receive pharmacologic and mechanical prophylaxis because of the incidence of progression and new acute DVT. They should also be counseled regarding the possibilities of recurrence and chronic venous insufficiency.

Full reference:Cannon, K.A. et al. (2017) The Prevalence of Chronic Deep Venous Thrombosis in Trauma: Implications for Hospitals and Patients. Journal of Trauma and Acute Care Surgery: Post Acceptance: 31 August 2017