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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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Emergency Care Workforce Programme

The Royal College of Emergency Medicine  & NHS Improvement | July 2018 | Emergency Care Workforce Programme: expected good practice

The Royal College of Emergency Medicine (RCEM) and NHS Improvement have produced the  Emergency Care Workforce Programme which sets out measures that providers have successfully put in place to achieve some stability in their workforce in difficult circumstances. We would expect all providers facing workforce challenges to consider their application.
The measures generally can be grouped into three themes:

  1. Creating a better working environment
  2. Offering incentives for people to work in EC
  3. Broadening the pool of available staff
Improvement
Image source: improvement.nhs.uk

The document can be read here


Ambulatory emergency care guide

This guide offers trusts useful guidance on emergency patient flow to identify a large cohort of patients who can safely be treated on the same day, reducing admissions and improving the patient experience.

The value of ambulatory emergency care (AEC) and same day emergency care (SDEC) is streamlining clinical processes so patient care can be delivered on the same day, reducing admissions and reliance on hospital beds — to improve patient flow.

Much of the growth in admitted non-elective activity is for patients who spend 1-2 days in hospital. Whilst it is a relatively new care model the AEC/SDEC aims to minimise and remove delays in the patient pathway allowing services to offer same day care as an alternative to hospital admission for at least 12 hours per day.

Full document: Ambulatory emergency care guide: same day emergency care — clinical definition, patient selection and metrics | NHS Improvement

 

The state of care in urgent primary care services

This report presents findings from the Care Quality Commission’s programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.

state of care
Image source: http://www.cqc.org.uk

Urgent primary care services play a vital role in England’s healthcare system. They are the first step to ensure that people are seen by the professional best suited to deliver the right care and in the most appropriate setting.  A quick, safe and effective response from these services provides a good outcome for patients and takes pressure off other parts of the urgent care system.

This report presents some common themes and characteristics that the Care Quality Commission (CQC) have found from their inspections.

The report found:

  • Urgent care services are an essential part of the healthcare system, particularly in taking pressure off other parts of the NHS at times of peak demand.
  • Urgent primary care services have been able to improve. Overall, the quality is good – although one in 10 services still require some improvement, particularly in initial assessment of people and timeliness of response to urgent needs.
  • Urgent care providers face pressures with staffing and workforce planning. This is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians
  • Many providers experience difficulties in accessing people’s medical records.
  • NHS 111 in particular has the potential to take pressure off the NHS – and provide a better experience for people by giving advice and treatment in one place. However, to achieve this it must be adequately resourced. Commissioners need to support providers, take action if they are not meeting their contracts and integrate services more closely.
  • Many people are not aware of the range of urgent care services available. There is a need for more public information – and consistency of service provision.

Full report: The state of care in urgent primary care services. Findings from CQC’s programme of comprehensive inspections in England

Facing the Future – standards for children and young people in emergency care settings

Royal College of Paediatrics and Child Health | June 2018 | Facing the Future – standards for children and young people in emergency care settings

 The Royal College of Paediatrics and Child Health has recently released Standards for Children and Young People in Emergency Care Settings (4th edition, published in June 2018). They were developed by the Intercollegiate Committee and are aimed at all health professionals working in emergency care.

These standards aim to ensure that urgent and emergency care is fully integrated to ensure children are seen by the right people, at the right place and in the right setting.

Facing the Future
Image source: rcpch.ac.uk

In total, there are 70 standards, covering the following areas:

  • An integrated urgent and emergency care system
  • Environment in emergency care settings
  • Workforce and training
  • Management of the sick or injured child
  • Safeguarding in emergency care settings
  • Mental health
  • Children with complex medical needs
  • Major incidents involving children and young people
  • Safe transfers
  • Death of a child
  • Information system and data analysis
  • Research for paediatric emergency care

Practice examples are included within the standards to support services delivering these standards. Metrics have been included and an accompanying audit toolkit is in development, to help monitor local progress and generate ideas for how standards can be best met.

Source: RCPCH

The standards can be read at RCPCH 
More information about the standards is here 

Updates to guidance for urgent care providers

Updated guidance on how Care Quality Commission (CQC) monitors, inspects and regulates urgent care services. This includes NHS 111 and GP out-of-hours services.

Key updates to the guidance include:

  • Updates to the provider information request so that we can better understand the care and the service you provide. This will include asking about the changes to your service since the last inspection.
  • Carrying out more focused inspections for providers with services rated as good and outstanding overall. This means we will not always consider all five key questions on each inspection.
  • More information on follow-up inspections.

Full document:
How we monitor, inspect and regulate urgent care services, including NHS 111 and GP out-of-hours services | CQC

Reducing emergency admissions

This Public Accounts Committee report states that the Government must improve preventive care outside hospitals , warning that hospitals, GPs, community services and social care need to work together more effectively | House of Commons Committee of Public Accounts

The Public Accounts Committee has published Reducing emergency admissions.  The Committee finds it lamentable that nearly 1.5 million people could have avoided emergency admissions in 2016–17 if hospitals, GPs, community services and social care had worked together more effectively.  They say it is frustrating that NHS England and partners are making some progress in reducing the impact of emergency admissions for patients and hospitals when they do happen, but no impact on reducing the numbers of admissions that could have been avoided.

The report make a number of recommendations, including:

  • NHS England should identify gaps in capacity in primary and community health care and set out how it intends to fill those gaps. 
  • NHS England’s and NHS Improvement’s regional teams should assess the capacity that hospitals need in terms of beds, staff and funding to deal with emergency admissions throughout the year.
  • The Department should encourage better sharing of best practice on how the voluntary sector supports health and social care efforts to reduce emergency admissions and understand the reliance the system has on the sector.
  • NHS England and NHS Improvement should improve data they collect and that hospitals record so that by the end of 2018 care can be tracked and publicly reported.

  • Read the report summary
  • Read the report conclusions and recommendations
  • Read the full report: Reducing emergency admissions

Under pressure: Safely managing increased demand in emergency departments

Winter 2017/18 saw an unprecedented demand for health and care support services. Emergency departments bore the brunt of this demand. This report features practical solutions from staff and calls for wider action for health and social care services to work together | Care Quality Commission

cqc pressure
Image source: http://www.cqc.org.uk

This report aims to contribute to the discussion about how those working in health and social care can come together in a more systemised way to encourage early and effective planning for not only winter pressures but for all periods of peak demand.
The report suggests that there is a need to develop a shared understanding of what an effective escalation strategy looks like – and longer-term, how health and care providers and commissioners collaborate to meet the needs of their local populations, with a stronger focus on keeping people well and helping them stay out of hospital.

The report concludes that the ongoing trend of increasing demand on health and social care services is not abating and it is clear that action is needed now to address the pressures on emergency departments, and in turn keep patients safe. Whilst the report recognises that there are no simple solutions to this problem, it identifies examples of good practice and potential immediate steps to take to manage these issues.

Full report: Under pressure. Safely managing increased demand in emergency departments