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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

Emergency readmissions to hospital for potentially preventable conditions on the rise, new research shows

Nuffield Trust | June 2018 | Emergency readmissions to hospital for potentially preventable conditions on the rise, new research shows

Data analysed by the Nuffield Trust shows that readmissions within 30 days of discharge for preventable conditions such as pneumonia and pressure sores increased by almost a fifth (19 per cent) between 2010/11 and 2016/17.

The new findings from QualityWatch, a major research programme from the Nuffield Trust and the Health Foundation, looked at hospital data detailing patient diagnoses and the reasons behind emergency hospital readmissions during this time (Nuffield Trust).

Key findings:

  • Between 2010/11 and 2016/17, the number of emergency readmissions within 30 days increased from 1,157,570 to 1,379,790, a rise of 19.2%. The proportion of patient hospital stays that were followed by a readmission grew from 7.5% to 8%.
  • Potentially preventable emergency readmissions to hospital grew from 130,760 to 184,763 – an increase of 41.3%. This means that the proportion of patient hospital stays that were followed by these types of readmission grew from 0.8% in 2010/11 to 1.1% in 2016/17.
  • Patients readmitted to hospital in an emergency with pneumonia increased from 41,003 in 2010/11 to 70,731 in 2016/17, an increase of 72.5%. The increase in pneumonia readmissions was greater than the overall increase in pneumonia cases.
  • Emergency readmissions for pressure sores almost trebled from 7,787 in 2010/11 to 22,448 in 2016/17. The increase in the number of patients being readmitted with a pressure sore superseded the overall increase in the number of pressure sore diagnoses in hospital.
  • The number of patients readmitted with venous thromboembolism grew by a third, from 16,890 in 2010/11 to 23,006 in 2016/17.

The full press release from the Nuffield Trust is available here 


In the media:

BBC News Rise in ‘preventable’ emergency readmissions to hospital

Emergency hospital admissions in England: which may be avoidable and how?

New research led by the Health Foundation looks at trends in emergency admissions over the past decade and reviews some of the interventions aimed at reducing them.

Key findings:

  • One in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions, such as heart disease, stroke, type 2 diabetes, dehydration, hip fracture or dementia. This is up from one in ten in 2006/07
  • The number of patients admitted urgently to hospital has increased by 42% over the past decade – that’s an average of 3.2% per annum. This far outstrips the total number of people who attend A&E departments, which is up by only 13%
  • Patients arriving at A&E are sicker than ever before, and more likely to need admission. This has grown for patients with multiple health conditions, as well as for older patients aged 85 or over, up by 58.9%
  • Hospitals are treating patients more quickly, with overnight stays for those with five or more conditions lasting 10.8 nights in 2015/16 compared with 15.8 days a decade previously. The number of these patients admitted to hospital but discharged on the same day have increased by 373% over the same period.

The briefing also identifies opportunities to reduce emergency admissions including:

  • Approximately 14% of all emergency admissions are for ‘ambulatory sensitive’ conditions – conditions such as asthma where timely and effective primary care could reduce the likelihood of admission
  • If older patients saw their regular GP two more times out of every ten consultations, this would be associated with a 6% decrease in admissions for ambulatory sensitive conditions
  • Around 26.5% of all unplanned A&E attendances in England (5.77 million per year) were preceded by the patient being unable to obtain a GP appointment that was convenient to them, however few of these A&E attendances will have resulted in an admission.

Full document: Emergency hospital admissions in England: which may be avoidable and how? | The Health Foundation

Statistical releases

NHS England and NHS Digital have released new statistics relevant to emergency care

NHS England  NHS 111 Minimum Data Set (March 2018 data) 

NHS England Ambulance Quality Indicators: Systems Indicators (March 2018 data)

NHS England Ambulance Quality Indicators: Clinical Outcomes (November 2017 data)

NHS England A&E attendances and emergency admissions for March 2018 and Quarterly report (Q4)


NHS Digital Provisional Accident and Emergency Quality Indicators for England February 2018, by provider

NHS Digital Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatients and Accident and Emergency Data – April 2017 to February 2018