Dr Vincent Connolly Clinical Director ECIST
Transcript of Dr Vincent Connolly Clinical Director ECIST
95% of the increase in short stay admissions
• Urinary disorders • Gastroenteritis / colitis • Tonsillitis • Cellulitis • Pneumonia (unspecified) • GORD • Convulsions • Abscesses, carbuncles
Default to Day Surgery
Suitability for day surgery Pathway
Clearly suitable
Unsure
Clearly unsuitable
Day surgery Home if ok
Inpatient care ? Home if ok
Inpatient care Hospital stay
20–30%
5–20%
40–65%
Models of AEC – 4Ps
• Passive – receive referrals
• Pathway driven – restricted to particular agreed pathways
• Pull – senior clinician takes calls for emergency referrals
• Process driven – all patients considered for AEC
Example of an AEC process model
ED
Ambulatory Emergency Care Centre
Acute Assessment Unit Wards
GPs
999
Walk Ins
Home and/or clinic
Home Clinic
Overarching principle; Treat all emergency patients as ambulatory until proven otherwise
Specialty admissions
Clinically unstable
Clinical conversation
4 simple questions
• Is this patient clinically stable?
• Is the patient functionally capable of being managed in the AEC Unit?
• Would this patient have been admitted to hospital before AEC existed?
• Could the patient’s needs be better met by another service?
Why is good practice not adopted?
• Culture & Beliefs • Weak system enablers • Leadership and management capacity &
capability • Staffing constraints • Estates constraints • Financial constraints
(R)evolution Outcomes
• It dies out and things go back to “normal”
• It stabilises
• It takes over and becomes the norm