Whittington Emergency Department Urgent Treatment Centre p l

Whittington Emergency Department & Urgent Treatment Centre ! p l He Dr Nathalie Richard Consultant in Emergency Medicine and Ambulatory care Whittington Health NHS Trust

GP Update • News from ED & UTC • GP Forward View • Emergency Referrals Audit • Making use of alternatives to ED • Streaming & Redirection

6% growth per annum

ED Attendances 112000 107000 102000 97000 92000 87000 Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

Supply Demand Actual average ho urly attendance data fo r last 3 months Doctors and ENPs rotas Local understandin g of break times and work patterns Split into streams: Majors, UCC, Paed s Understanding of time needed for e ach type of patient

Discharge Letters • Complete on EPR • Record name, dose and duration of any medication prescribed • Any alterations to usual treatment regime • Arrangements for wound management • Discharge advice given • Note any action points for GP, but do not tell them what to do – patient to arrange review • Do not ask them to “chase”! • Remember you are writing to a senior clinician

Emergency Referrals Audit • Are normal referral practices followed? • Do referral practices affect total time in ED? • Can we make any recommendations?

Emergency Referrals Audit • Are normal referral practices followed? • Do referral practices affect total time in ED? • Can we make any recommendations? • 6 week period in Jan/Feb 2018 • Staff asked to identify GP referrals • 195 patients identified and notes reviewed

Emergency Referrals Audit • Did they have a letter? • Were they expected by a team? 87% had a letter • 25% had a letter and were expected 172 mins • 11% had a letter to specialty but not expected • 1% no letter but expected by a specialty team • 52% had a letter addressed to ED • 11% no letter, not referred or expected 225 mins

75% of referrals are discharged

Emergency Referrals Audit • Discussed at Clinical Interface Group • How to Refer guidance • Reaudit… very similar results… • Please include on letters: • Best specialty to see this patient • Whether they are likely to be admitted • What do they need?

Maximise the alternatives!

Ambulatory Care • Any patient who you think may not need to be admitted but needs urgent investigation or specialty review • Surgical AEC pathways • New Call waiting feature • 10 -12 Clinic • Gynae Assessment Unit

Streaming & Redirection

Take home messages • We understand that you are busy too! • ED is popular and overcrowded. • Many referrals are not expected. • Include intended specialty team on letter. • Maximise use of alternatives.

Whittington Emergency Department & Urgent Treatment Centre Dr Nathalie Richard Consultant in Emergency Medicine and Ambulatory Care Whittington Health NHS Trust