WORKSHOP How do we manage acute care as safely as a day case. The hospital without walls – delivering ambulatory emergency care. Dr Ian Sturgess Clinical Lead, Intensive Support Team Urgent and Emergency Care. Ambulatory Emergency Care - Concept.
Dr Ian Sturgess
Clinical Lead, Intensive Support Team
Urgent and Emergency Care
Focus on CDM and more effective responses to urgent care needs – ACS condition management
Clear operational performance framework and integrated in to primary care
Improved integration with primary care responders
Front load senior decision process incl primary care
General Practice & GP OOH
Ambulance Service & GP OOH
Redesign to left shift LOS
Optimise ambulatory emergency care
Information flow converting the unheralded to the heralded
Alternatives to acute admission settings
Alternative access for diagnosis
Alternative settings for therapy
Alternative sites for discharge
Alternative sites for readmission
How to do it:
Structure – physical and organisational
People and behaviours
% of total
No. of Adj.
No. of Ad.
GM11 Chest Pain
GS01 Acute abdominal pain not requiring operative
TO02 Appendicular fractures not requiring
immediate internal fixation
GM31 Falls including syncope or collapse
GM29 Deliberate self harm
GM08 LRTI without COPD
GM10 Supraventricular tachycardia
GM14 & 15 First seizure and seizure in known
Total Non-zero LOS Emergency Admissions
18.1%NHS South East Coast – 2007/08 Opportunities Assessment – Non-Zero LOS Admissions
Segmentation – volume and engagement
High level process map
identify the bottlenecks
Prevent initial failure using intent and standardization
Identify defects and mitigate
using redundancy and contingency
Measure and then communicate learning from defects back into the design process
Clear and measurable aims
Real time measurement
Small tests of change
Plan, Do, Study, Act (PDSA)
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?