The (R)evolution of Ambulatory Emergency Care Dr Vincent Connolly Clinical Director ECIST

Vincent Connolly

Because its complex!

Why is emergency care so challenging?

95% of the increase in short stay admissions

• Urinary disorders • Gastroenteritis / colitis • Tonsillitis • Cellulitis • Pneumonia (unspecified) • GORD • Convulsions • Abscesses, carbuncles

Value Equation

Patient experience X Patient Outcomes

Cost

Doing things differently

Anatomy

Physiology

Psychology

(R)evolution starts here

Patient Selection is the key step

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

The (R)evolution of suspected PE management

(R)evolution Outcomes

• It dies out and things go back to “normal”

• It stabilises

• It takes over and becomes the norm

If I cant dance I don’t want to be part of your revolution.

Emma Goldman