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Acute Medicine – an out-patient specialty?

Acute Medicine – an out-patient specialty?. Dr Vincent Connolly The James Cook University Hospital Middlesbrough. What is Ambulatory Emergency Care? RCP (L) Acute medicine taskforce:-.

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Acute Medicine – an out-patient specialty?

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

  2. VConnolly

  3. VConnolly

  4. What is AmbulatoryEmergency 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 out-patient services that can be provided across the primary/secondary care interface. VConnolly

  5. 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

  6. 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

  7. 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

  8. How to get started • Location, 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

  9. Funded clinic facility 4 trolleys 4 consulting rooms Staff room Storage area Waiting area Discharge lounge Out of Hours Primecare centre Developments In Acute MedicineEnvironment changesin collaboration with the PCT VConnolly

  10. 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 Nursing Staff VConnolly

  11. 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

  12. 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

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

  14. Space…Space….Space • On average the AAU clinic receives 23 patients per day • Procedure room - development VConnolly

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

  16. Risk adjusted mortality – trust overview VConnolly

  17. Risk adjusted length of stay VConnolly

  18. Ave Length of Stay – General Medicine VConnolly

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

  20. Thank you Any questions? VConnolly

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