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HEAT T10. Mr David Chung Clinical Director, Emergency Medicine Ayrshire and Arran. Targets. The Good “the 4 hour target”. Targets. The bad 5 Year plans Great Leap Forward HEAT H5? HEAT H4?. Targets. The Ugly Vietnam War “War on drugs” Credit Crunch. Targets or Goals?.

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Presentation Transcript
heat t10

HEAT T10

Mr David Chung

Clinical Director, Emergency Medicine

Ayrshire and Arran

targets
Targets
  • The Good

“the 4 hour target”

targets1
Targets
  • The bad
    • 5 Year plans
    • Great Leap Forward
    • HEAT H5?
    • HEAT H4?
targets2
Targets
  • The Ugly
    • Vietnam War
    • “War on drugs”
    • Credit Crunch
emergency medicine
Emergency Medicine
  • Provide care to undifferentiated self presenting patients, 24/7/365
  • No exclusions
what is unscheduled care
What is unscheduled care
  • If you can appoint, isn’t that planned?
ed access
ED Access

Decide need

Get there

Book in

slide9

Phone Someone

Decide Need

Appointed

Wait

Transport

Book in

slide11

We are not contracted to provide care for minor injuries. If you have an injury please go the Accident Infirmary at the Victoria Infirmary.

back to heat t10
Back to HEAT T10
  • What has this got to do with Emergency Medicine?
role of emergency medicine
Role of Emergency Medicine
  • To gather information
  • To direct this to someone who can do something with it, possibly with advice
  • To develop redirection pathways
story so far
Story so far
  • Information
    • Demographics of attendees
    • Analysis of attendance to identify possible redirection
demographic stuff
Demographic stuff
  • Stewart Cardwell’s analysis of Ayrshire attendances
    • 17-35 year olds make up 25.5% of workload
    • Of 79% are self presenters or 999
    • Only 20% get admitted, 40% are discharged without review
analysis
Analysis
  • Casenote review of 1733 patients, about 5-10% of out of hours attendances should be primary care
  • 2.5% attendances are psychiatric
redirection pathways
Redirection pathways
  • Currently:
    • Go to A&E
  • For the future;
    • Back to relevant community based care
potential progress
Potential progress
  • Front door redesign
  • Re direction
  • Cross fertilisation
changing behaviour
Changing behaviour
  • Futile unless experiential learning
    • Advantages clearly demonstrated
    • Sanctions applied