‘Call before convey’ – delivering urgent care for patients in the right place with the right clinician, first time

Abstract

Aims and Objectives Aim: Ensure patients have timely access to the right urgent care, in the right place with the right clinician. Many people access urgent care via the emergency department (ED) resulting in poor patient experience, delays to care and duplication, also causing overcrowding, leading to harm. Method and Design Using the model for improvement we defined aims and set measures, including number of patients offered alternatives to ED or admission, with balancing measures of patient reattendance/readmission. The data identified pathways with largest impact potential - chest pain, dyspnoea and falls/frailty/head injury. Working with our trust clinical communication centre (CCC) as single point of access, ambulances called before conveying patients in these pathways. We worked with specialty consultants from Cardiology, Respiratory, Frailty, Emergency Medicine and Acute Medicine to offer senior decision maker input to pre-hospital conversations to define the best urgent care pathways. We engaged with community falls car, urgent care response team and GPs along with hospital SDECs and virtual wards as well as providing specialty ‘hot clinic’ appointments where appropriate, to provide alternatives to ED and admission. In addition these pathways could be utilised by GPs referring via CCC, and ED where a patient could be given an alternative to admission. We used daily huddles to enact rapid cycle PDSA changes. After a first pilot we added additional pathways for a second pilot, converting to business as usual within 6 months. Results and Conclusion Across the pilots, 32-38% were given an alternative to ED attendance or admission. 24% avoided hospital entirely. We reduced ambulance lost minutes by 84-87 hours compared to the previous 3 week average. Streamlining access to urgent care pathways with a single point of access benefits these patients but also those who do attend by reducing harm from overcrowding through better ED and hospital flow by offering alternatives to ED attendance and admission. https://emj.bmj.com/content/40/12/871.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/