Content area
Full text
ACUTE CARE
Remodelling emergency care so that ambulatory, single-day treatment is the default improves patient experience and staff satisfaction. By Deborah Thompson and Vincent Connolly
Royal colleges and clinical teams across England have recognised that a new approach is needed to transform emergency care and reduce pressure on the system.
The College of Emergency Medicine made 10 recommendations in its report, Drive for Quality, published earlier this year.
One recommendation was that clinical decision units and ambulatory emergency care are important components of the emergency systems.
The Future Hospital: Caring for Medical Patients report, published last year by the Royal College of Physicians, recommends that "care will be organised so that ambulatory (day case) emergency care is the default position for emergency patients, unless their clinical needs require admission".
It continues: "Systems will ensure ambulatory care patients continue to receive prompt specialist care aligned to their needs, maximising alternatives to acute hospital admission and improving safety, outcomes and experience of patients in ambulatory care."
Breaking tradition
The RCP defines ambulatory care as: "Clinical care, which may include diagnosis, observation, treatment and rehabilitation, not provided within the traditional hospital bed base or within the traditional outpatient services that can be provided across the primary/ secondary care interface
The ambulatory emergency care approach is based on the Directory of Ambulatory Emergency Care for Adults, a publication that lists 49 emergency clinical scenarios suitable for ambulatory or same-day emergency care inpatients that are traditionally admitted to a hospital bed overnight.
The directory was first published by the NHS Institute for Innovation and Improvement in December 2007 and has been reviewed regularly. The third version was published in November 2012.
Using ambulatory emergency care, appropriate emergency patients are diagnosed and treated on the same day and sent home with ongoing clinical support and supervision as needed.
This approach has improved both clinical...