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10 tips on improving urgent and emergency care

Four organisations whose members are responsible for the care of acute patients in hospital, have set out ten priorities for action to address the challenges faced by urgent and emergency care services. These challenges include: rising demand, lack of alternatives to hospital admission, discharge issues, handover and flow, staff recruitment.

In spring 2013, the Royal College of Physicians (RCP), NHS Confederation, the Society for Acute Medicine and the College of Emergency Medicine brought together frontline professionals, leaders, policymakers and innovators in health care to consider the future for urgent and emergency care services. The priority areas for action below are a direct output of those discussions:

1. We must develop effective and simplified alternatives to hospital admission across seven days

We must ensure that patients have access to expert diagnosis and assessment in different settings, and ensure there is clear information on the services available to them. These services should be centred around, and respond to, both the physical and mental health needs of patients.

2. We must adjust the financial incentives across the system so that they support effective management of demand for unscheduled care

We need the resources to invest in primary, community and social care, so they can contribute to providing effective urgent and emergency care services. The marginal tariff provides a mechanism to realise this investment, which should be transparent and driven by local commissioners.

3. We must focus on supporting patients to leave hospital seven days a week

Hospital teams should ensure early planning for discharge from hospital, involving a range of health care professionals.  The use of ‘step down’ care facilities who need supportive care but not a hospital bed, should be extended.

4. We must organise high-quality consultant-led hospital services across seven days

We must reorganise hospital care so that patients have access to consultant-led care regardless of the day of the week. A consultant physician should always be available ‘on call’ and should be present in the acute medical unit for at least 12 hours per day, seven days per week with no concurrent duties except the delivery of care to acute admissions.

5. We must promote greater collaboration within the hospital and beyond to manage emergency patients

We must promote a collaborative model of care, including senior-decision making in the emergency department and acute medical unit. Multi-specialty teams, with expertise in physical and mental health, should work in a network across the hospital and community to manage patients on an emergency care pathway.

6. We must ensure there is sufficient capacity within the hospital, and the wider system, to meet changing demand

We must ensure that there is adequate bed and staffing capacity to meet the needs of patients admitted as emergencies. Wherever possible each day should start with some unoccupied beds on the AMU. Likewise, community health and social care capacity, with appropriate support from medical teams, should be increased, in order to absorb preventable unscheduled admissions.

7. We must focus on ambulatory (‘day case’) emergency care where appropriate

Those involved in commissioning and planning emergency care services must focus on ambulatory emergency care where they can, setting out which admissions they consider to be avoidable, and what proportion should be more appropriately managed in the community. This should relieve pressure on the AMU, the Emergency Department and more widely within the hospital.

8. We must develop a sustainable workforce, fit for the future

We need to ensure that emergency medicine and acute medicine remain attractive career options.  Job planning must take into consideration the intensity of workload as well as the numbers of hours worked to ensure the long-term sustainability of a consultant career in these acute specialties.

9. We must show leadership

We must further enable leadership development and cultural change within the NHS, through promoting evidence-based decision making, new organisational values and behaviours, and public transparency.

10. We must focus on public health and preventive health strategies

We must support early intervention and preventative strategies where extra investment on community and preventive health is required; specifically, the future payment mechanism should be designed to support coordination of these services.

Read the full report.

Attend Acute and General Medicine Conference 2013.

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