Acute Medicine an outpatient specialty Dr Vincent Connolly

Acute Medicine – an out-patient specialty? Dr Vincent Connolly The James Cook University Hospital Middlesbrough VConnolly

VConnolly

VConnolly

What is Ambulatory Emergency Care? RCP (L) Acute medicine taskforce: - Ambulatory care is 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. VConnolly

Categories of Ambulatory Emergency Care 1. Diagnostic exclusion group Eg chest pain rule outs etc (many already in place) 2. Low risk stratification group Eg low Rockall score GI bleed 3. Specific procedural group Eg effusion drainage 4. Infra-structural group Eg care home admissions VConnolly

Selection of clinical diagnoses appropriate for ambulatory care Gastroenterology – – – Upper gastrointestinal (GI) bleed with Rockall score of 0 Lower GI bleed with no haemodynamic compromise Painless obstructive jaundice Non-acute abdominal pain Diarrhoea and vomiting Endocrinology – – – Hyperglycaemia without ketosis Hypoglycaemia with full recovery Type 1 diabetes without ketosis Electrolyte imbalances Thyroid disease Infectious diseases – Cellulitis – Osteomyelitis VConnolly

Services which can be linked to Ambulatory Care Chronic obstructive pulmonary disease outreach Pleural diseases clinics Rapid access chest pain clinics Transient ischaemic attack/stroke clinics Epilepsy clinic Pain management service Functional assessment and support teams Diabetes nurse specialist Falls clinic Macmillan nurses Outpatient parenteral antibiotics team Endoscopy services Heart failure team VConnolly

How to get started Location, location – – Ideally close to A&E & AAU Waiting facilities Consulting rooms Trolleys People – – – Enthusiastic capable clinicians, nurse practitioners HCAs/generic workers Senior management Diagnostic support – Pathology – Radiology Clinical guidleines/algorithims/patient flow – Agreed Clinical Outcomes & Process Measures – Activity VConnolly

Developments In Acute Medicine Environment changes in collaboration with the PCT Funded clinic facility – 4 trolleys – 4 consulting rooms – Staff room – Storage area – Waiting area – Discharge lounge Out of Hours Primecare centre VConnolly

Nursing Staff Sister on every shift Nurse practitioners – Clerking patients & developing management plan – Specialty links Training – Clinical skills – ALS - ALERT course (identification and management of the critically ill patient). Develop health care assistants & generic workers VConnolly

This slide (containing an example of good practice) has been removed to reduce the size of the presentation. To receive an email copy of the complete presentation, please email vincent. connolly@stees. nhs. uk VConnolly

What are the advantages of developing emergency care in an ambulatory setting? Patient acceptability More specialist care for patients Structure and predictability to the emergency process Training opportunity Clinical & cost effective Alleviates bed pressures Reduces A&E attendances VConnolly

Fast Acces. S to Therapist team Activity 8% Transfers to non acute beds 1721 patients referred 4% Unsuitable patients Patients discharged home via FASTeam Patients 22% remaining in acute hospital bed 66% VConnolly

Space…. Space Day On average the AAU clinic receives 23 patients per day Procedure room - development AM PM Monday 1. Nurse Led DVT / PE clinic 2. Gastro clinic 1. TIA clinic 2. Dr Nag Diabetes and GM clinic Tuesday 1. Nurse Led DVT / PE clinic 2. Dr Hamad Thromboembolic Disease and Heat Failure clinic 1. TIA clinic 2. Dr Guhan Pleural Disease clinic Wednesday 1. Nurse Led DVT / PE clinic 1. TIA clinic 2. Dr Guhan Chest clinic 3. Dr Whitfield GM clinic Thursday 1. Nurse Led DVT / PE clinic 2. Dr Hamad Thromboembolic Disease and GM clinic 1. TIA clinic 2. Dr Whitfield Chest and GM clinic Friday 1. Nurse Led DVT / PE clinic 1. TIA clinic 2. Dr Connolly- Dr Hamad GM clinic VConnolly

Activity As the activity continues to rise, so too does the number of patients discharged from the directorate. VConnolly

Risk adjusted mortality – trust overview VConnolly

Risk adjusted length of stay VConnolly

Ave Length of Stay – General Medicine VConnolly

Primary Care A&E dept Self Referral Community Self Care Intermediate / Community beds Primary care Mental Health Medical Assessment Unit ITU/HDU Specialist care Social Care AMBULATORY EMERGENCY CARE General care Acute VConnolly FASTeam DVT/PE OHPAT Rapid Access Clinic Chest Pain Clinic Heart Failure Team Diabetes Team COPD Outreach Macmillan Team

Thank you Any questions? VConnolly