HEAT 10
“An Emergency Medicine perspective”
HEAT 10
“An Emergency Medicine perspective”
Alasdair Gray Alasdair Gray Consultant in Emergency Medicine, EdinburghConsultant in Emergency Medicine, Edinburgh
Demand + activity Demographics
Disease chronicity
Front-door Emergency Activity at RIE, SJH and WGH, 2003-2007
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
110,000
RIE Total Front Door SJH A&E WGH ARAUT
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008
RIE Emergency Dept Activity, Referral Comparison - May 03 - Mar 08
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
May-03Jul-03Sep-03Nov-0
3Jan-04Mar-0
4May-04
Jul-04Sep-04Nov-0
4Jan-05Mar-0
5May-05
Jul-05Sep-05Nov-0
5Jan-06Mar-0
6May-06
Jul-06Sep-06Nov-0
6Jan-07Mar-0
7May-07
Jul-07Sep-07Nov-0
7Jan-08Mar-0
8
No.
of P
atie
nts 999 Emer
GPNHS 24Self-Ref
RIE Front-door Sources of Referral, Aug 07 - Jul 08
Self Referral to A&E45%
999 Emergency29%
GP / Bed Bureau13%
NHS 246%
Police1%
WGH - MIU1%
LUCS3%
Unplanned Return1%
Other/Unknown1%
RHSC ED, Sources of Referral, Aug 07 - Jul 08
Self Referral to A&E66%
999 Emergency5%
GP / Bed Bureau12%
NHS 245%
WGH - MIU1%
Other/Unknown4%
Hospital (not in LUHD)1%
Unplanned Return2%
SJH1%
LUCS3%
There is a story about a philosopher and a psychologist having a drink. The philosopher asks: why did the chicken really cross the road? The psychologist replied: well, as the chicken lacks any formal reasoning or decision making capabilities, it seems unlikely that its action was spurred by any conscious motivation, so I’d say it was instinct.
Culture + Expectations
System complexity
Community pharmacy
HEAT 10 + Emergency Medicine
NHS Lothian: Some small steps…….
• Direct transfer of patients to LUCS
or own GP
• Frequent attenders management
• Primary Care Physician in
Emergency Department
• Understanding of patient decisions
Emergency Department transfer to LUCS
0
100
200
300
400
500
600
Aug-08Sep-08Oct-08Nov-08Dec-08Jan-09Feb-09Mar-09Apr-09May-09
RIESJHNHS Lothian
Frequent attenders
• 57 patients attended ED >10 times in 6/12 h
(1.4% attendances)
• Median number of attendances 12
(interquartile range (IQR) 10–14)
• Following intervention median attendances
dropped to 6 (IQR 2–13, p<0.001)
• Total number of attendances dropped from
720 to 499 (31% reduction)
Skinner, J et al. Emerg Med J 2009;26:103-105
Multifactorial clinical presentations
Skinner, J et al. Emerg Med J 2009;26:103-105
Breakdown of case management into categories
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