Redesigning Emergency Services

1. Khurshid Alam
FCEM, MRCS, MSc and MBBS

2. Opportunities for redesigning
Emergency Care Pathways at NUH?
Objective:1.
What are the elements exerting pressure on NUH Emergency Dept.
2.
What are at present and what will be the demands on Emergency
care services in future?
3.
How to transform the existing Emergency Care Services to fulfil
future demands?
4.
Summary and Conclusion.

3. Elements exerting pressure on NUH
Emergency Dept
Performance
Measures
Fragmented
Fragmented
Primary and
Primary and
Secondary
Secondary
Care
Care
Increased
Activity
Staffing
Pressures
pressure
on NUH
Emergency
Dept
http://www.foundationtrustnetwork.org/resource-library/emergency-care-andemergency-services-2013/ +Personal Views.
Poor Flow of
Patient Data
Funding
Shortage

4. Increased Activity
• 3% rise in annual attendance nationally
• Growth in chronic diseases
• Frail elderly
http://cms.nottinghamshire.gov.uk/jsna-chapter2.pdf

5. Staffing pressures
• Recruitment of Middle grades
• Senior cover on shop floor
• Reliance on bank and locum staff
Consultant
18.7/27
Middle Grade 5/9
Locums MG
5-6/day
http://www.england.nhs.uk/2013/11/13/keogh-urgent-emergency

6. Performance Measures
• 4 Hours target
• Clinical Quality Indicators
• Friends and Family Test
NUH ED Weekly Report
Wednesday 15th to Tuesday 21st Jan 2014
4 hour target of 95% was not achieved by ED
on any day
4 HOUR TARGET
PERFORMANCE
ED
Eye
Casualty
Combined
A&E
REPORTING WEEK
90.73%
99.73%
91.74%
FY to end reporting week
93.26%
99.86%
94.00%

7. A Picture of Fragmented EHCS and Society's Unawareness
5-Minor Illness and
Injury- Walk in Centre
6-Severe Chest PainShould be Front of
the Queue
4-Painful
StomachGP
2-Uncertain
/confused
–call NHS111
3-Painful CoughPharmacy
1-Sore Throat
Self Care

8. New Health Services and Funding Arrangements

9. Emer. Admission
Emergency Depts.
Number of patients
Walk In/ Urgent Care
Primary care
Self care
Moving the patients down in the pyramid should
be aim of NUH
Resources
Dorset Pyramid of Redesigning Emergency Care Services

10. Redesigned NUH Emergency Health Services
RADIOLOGY
Hospitals
Resus
RAT
Major
Area
Paed.
A&E
Emergency Medicine Departs.
SelfCare
Pharmacy
NEM
Minor
Injury
Acute Mental
and Alcohol
Services
Single point of access
Social
Services
Walking Patients
FACT
Team
Stream Lining Co-ordinator
GPs

11. Opportunities for NUH after Redesigned Acute Emergency
Services(AMS)
1-This particular redesigned of NUH-AMS will bring under one roof , Primary care,
Social Services and Community Services working along with NUH.
2-Patients will receive AMS based on their health needs, utilization effectively and efficiently
of AMS, reducing waste and duplication of efforts. Thus addressing the issue of reduced
Funding.
3-Co-ordinated flow of patient, increasing the satisfaction and experience of patients.
4- NUH and Others Organizations should develop the co-ordinated pathways of Common
conditions.
5-NUH should develop and train its permanent workforce, Increasing ANP, ENP, Non-Deanery
training AE fellows, speciality consultant working in A&E addressing Staff Shortage.
6-This redesigned model will help NUH to achieve national targets, Foundation Status and
would be help to be England's Best Acute Teaching Hospital by 2016.

12. Summary and Conclusion
1-Redesinging the Mould rather than Base of The Whole Emergency Care
Services.
2-Adopting a Uniform Triage Systems by NHS Direct or 111 NHS , Based on
EBM and Involvement of all stakeholders.
3-Clarity of extent of functions of each component of Emergency Care
Services to relieve the confusion among Patients and Health Care
Providers.
4-Desiging functioning pathways, respected and adopted by whole
Emergency Care Services
5-Adopting a Uniform Monitoring system across all the components of
Emergency Care System .
6- Affective Net-working among all the component for rapid communication
and avoiding duplication.