Doctors develop standards to improve emergency outpatient care

Outpatients receiving urgent and emergency care across the NHS are set to benefit from new standards developed by two leading medical bodies.

The Royal College of Physicians of Edinburgh (RCPE) and the Society for Acute Medicine (SAM) have jointly produced standards for same day emergency care, also known as ambulatory emergency care (AEC).

AEC is a service that provides same day (outpatient) emergency care to hospital patients where they can be assessed, diagnosed, treated and are able to go home the same day without being admitted overnight.

In a report released in November, Winter 2018/19 in the NHS: The solutions, SAM called on the government and NHS leaders to “realise urgently” the potential of AEC.

The Society estimated that just a 5% increase in the number of patients who receive their first assessment and subsequent treatment in AEC could save an additional 238 overnight bed stays – equating to the prevention of 14,042 overnight admissions over the months of January and February.

As a result of SAM’s focus on AEC and data published in the Society for Acute Medicine Benchmarking Audit, AEC was incorporated into the NHS Long Term Plan and, in March, NHS England announced every major hospital will provide same day emergency care services by next winter.

“The Society urged the government in the report ‘Winter 2018/19 in the NHS: The solutions’, to look at “how much could be achieved with investment in this area” and address why the implementation of AEC units was “not standard or uniform” across the country,” said Dr Scriven.

“This was followed by the incorporation of AEC into the NHS Long Term Plan with a target of increasing the proportion of patients looked after in this way and the establishment of a joint NHSE/NHSE/specialist societies group to make this a reality by late 2019.

“Underpinning the process has been a real need for standards written by a group of experienced physicians who work in that area and are seen as subject ‘experts’.”

He added: “This is the first time that standards for AEC units have been produced and it is hoped that all providers, those writing policies and those commissioning services will adopt them as soon as possible.”

Dr Mike Jones, director of training at RCPE and a consultant in acute medicine, said:

“AEC is an important service which provides same day hospital care to patients. AEC units treat a wide variety of common conditions including headaches, diabetes, deep vein thrombosis and cellulitis.

“These joint standards by RCPE and SAM aim to define the standards that should be adopted in ambulatory emergency care units. We think that patients deserve to be seen by a doctor or a nurse promptly, and then to have the best treatment possible.

“We believe that these standards will speed-up and improve patient care and ensure that patients have clear advice on what to do if their condition deteriorates after being discharged from hospital.

“They should also reduce admissions and readmissions, free up valuable hospital beds for those patients who most need them and provide a much needed boost for our hard-pressed hospitals, the staff who work in them and the NHS as a whole. “

The standards say:

  • Patients should be initially seen within one hour of entering an AEC unit.
  • Patients will be initially examined by a doctor or nurse, and an assessment will be made based on their symptoms, past medical history and details of any medications they are taking. Patients may need to have some diagnostic tests, like an X-ray or ultrasound scan, and the aim is to get the test results to patients on the same day.
  • During the period of care under the ambulatory team, patients should have clear written instructions for if they feel they are deteriorating or if they wish to discuss concerns prior to their next scheduled visit.
  • Patients should be seen promptly and certainly within one hour by a clinician who has the capabilities to assess and investigate the patient’s symptoms and signs. This clinician should have immediate access to a more senior clinical decision maker for review when the presentation proves more complex.
  • All units undertaking AEC should regularly survey a representative and consecutive number of patients under their care. This should take the form of a short questionnaire. At least 5% of all patients should be surveyed and the total time spent in the unit for each patient should be calculated. This data should be used to improve patient care.
  • A consultant physician should be available on the hospital site day and night throughout the opening times of the AEC unit, to review AEC patients.
  • A nominated clinician from the multi-disciplinary team (MDT) should take responsibility for the overall leadership of the AEC unit to ensure there are active clinical governance and quality improvement processes and strategies.

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