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Dr Ian Sturgess Clinical Lead, Intensive Support Team Urgent and Emergency Care PowerPoint PPT Presentation


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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.

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Dr Ian Sturgess Clinical Lead, Intensive Support Team Urgent and Emergency Care

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Dr ian sturgess clinical lead intensive support team urgent and emergency care

WORKSHOPHow 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

Ambulatory Emergency Care - Concept

  • Ambulatory emergency care (AEC) vs ambulatory care sensitive conditions (ACS)

  • AEC is a different way to manage patients who have an acute illness.

  • AEC is to emergency care, as day case surgery has been to elective care.

  • ACS conditions are where better long term condition management or preventative healthcare avoids the development of the acute condition.

  • They are complementary but the impact is at a different point in the care continuum.


A whole system perspective

A whole system perspective

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

Inpatient

Wards

MAU/SAU/

Short Stay

Community Support

A+E

Redesign to left shift LOS

Optimise ambulatory emergency care

Health Promotion

Information flow converting the unheralded to the heralded

Preventative/

Predictive care

Disease management

Managed populations

Alternatives to acute admission settings

Alternative access for diagnosis

Alternative settings for therapy

Alternative sites for discharge

Alternative sites for readmission

Discharge Process


Categories of ambulatory emergency care

Categories of Ambulatory Emergency Care

  • Diagnostic exclusion group

    • Eg chest pain rule outs etc (many already in place)

  • Low risk stratification group

    • Eg low Rockall score GI bleed

  • Specific procedural group

    • Eg effusion drainage

  • Infra-structural group

    • Eg advanced care planning for nursing homes


Ambulatory emergency care

Ambulatory Emergency Care

How to do it:

Opportunities

Implementation

Structure – physical and organisational

People and behaviours

Processes

Bundles

Reliability

Measurement

Outcome metrics

Process metrics

Balancing metrics


Nhs south east coast 2007 08 opportunities assessment non zero los admissions

% of total

% of total

No. of Adj.

No. of Ad.

Clinical Scenario

admissions

admissions

Ad.

-

Low

Ad.

-

Upper

(low)

(upper)

Total admissions

368,762

368,762

GM11 Chest Pain

3,227

3,638

0.88%

0.99%

GS01 Acute abdominal pain not requiring operative

intervention

2,206

2,553

0.60%

0.69%

TO02 Appendicular fractures not requiring

immediate internal fixation

3,061

4,453

0.83%

1.21%

GM31 Falls including syncope or collapse

2,373

3,339

0.64%

0.91%

GM24 Cellulitis

1,977

2,887

0.54%

0.78%

GM29 Deliberate self harm

2,094

2,788

0.57%

0.76%

GM08 LRTI without COPD

1,262

2,140

0.34%

0.58%

GM10 Supraventricular tachycardia

1,422

2,137

0.39%

0.58%

GM14 & 15 First seizure and seizure in known

epileptic

1,389

1,976

0.38%

0.54%

Etc. etc.

Total Non-zero LOS Emergency Admissions

32,186

46,111

12.2%

18.1%

NHS South East Coast – 2007/08 Opportunities Assessment – Non-Zero LOS Admissions


Phase 1 project set up

Phase 1 - Project Set Up


Pick conditions

Pick Conditions


Identify team

Identify Team

  • Clinical lead(s): clinicians should be willing to take the lead and to think beyond their own specialties

  • Nursing lead: the lead doctor and lead nurse should work closely together to develop and implement new processes

  • Senior manager support preferably at executive level: dynamic management is invaluable in coordinating supporting processes

  • Primary care and/or PCT representation

  • Assessment Unit - If you have an Assessment Unit, be sure to have at least one representative from this unit in your group.

  • Stakeholders - diagnostics, AHPs etc


Establish measures and objectives

Establish Measures and Objectives


Planning and implementation

Planning and Implementation


The reliable design strategy

The Reliable Design Strategy

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


The model for improvement

The Model for Improvement

Clear and measurable aims

How much

By when

How measured

Real time measurement

Outcome

Process

Balancing

Small tests of change

Plan, Do, Study, Act (PDSA)

Start tomorrow!


Dr ian sturgess clinical lead intensive support team urgent and emergency care

Model for Improvement

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?

Act

Plan

Study

Do


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