Source · GIRFT National Specialty Report

Emergency Medicine

Published 1 September 2021 Emergency Medicine Lead: Chris Moulton and Cliff Mann

GIRFT Programme National Specialty Report on emergency medicine

View on GIRFT ↗ · Download Report PDF ↗

Summary

28 recommendations 10 addressees 3 of 28 linked to a body

Recommendations

28 total

Rec 1 Trusts; Commissioners

Trusts, working with commissioners, to determine and fully understand their local demand and then ensure that both the hospital and ED capacities match that demand.

Rec 2 Trusts; Commissioners

Trusts, along with commissioners, to identify the ED burden arising from both new and existing services in primary, secondary and tertiary care, and to put measures in place to manage and mitigate that burden.

Rec 3 Commissioners; Trusts

Commissioners to work with trusts to enable a targeted expansion in the provision of hospital bed capacity to manage local demand.

Rec 4 Trusts

Trusts to benchmark the number and adequacy of their ED cubicles, isolation facilities, resuscitation areas, x-ray and computed tomography (CT) capacity, and staffing to ensure that overall capacity at least meets the current national mean.

Rec 5 Trusts; Commissioners

Trusts to work with their commissioners to optimise the provision of SDEC and urgent clinic access, including the supporting imaging, as outlined in the NHS Long Term Plan and NHS Planning Guidance (2019 and 2020).

Rec 6 Trusts

Trusts to ensure timely access to urgent care services and specialist opinions such that patients only attend ED when it adds value to their care.

Rec 7 Trusts

Trusts to ensure that all admissions occur: within one hour of completing the necessary ED investigations and treatment; and within six hours of arrival.

Rec 8 Trusts

Trusts to assess their number of six-hour breaches, review ED flow and take action to improve hospital capacity and systems accordingly.

Rec 9 Trusts

Trusts to produce a monthly report of the ED casemix variation and use this data to monitor and improve services.

Rec 10 Trusts

Trusts to measure all event and flow times from the patient's time of arrival.

Rec 11 Trusts

EDs to report all breaches of 12 hours from time of arrival.

Rec 12 CQC

Care Quality Commission to review 12-hour breach records as part of their routine inspection.

Full addressee: CQC

Rec 13 Trusts

Trusts to monitor and report the Aggregated Patient Delay (APD) at 6 and 12 hours as key metrics for measuring ED performance.

Rec 14 NHS England and NHS Improvement; CQC

NHS England and NHS Improvement and the CQC to use the Aggregated Patient Delay (APD) metric in their reviews.

Rec 15 Trusts

Trusts to use their Summary Emergency Department Indicator Table (SEDIT) to understand their demand, capacity, flow and outcome rankings, and take action accordingly.

Rec 16 Trusts

Trusts to evaluate the causes and consequences of their current GIRFT-EM quadrant position and take appropriate action.

Rec 17 Commissioners

Commissioners' funding systems to reflect accurate and actual costs incurred and reported nationally in the provision of efficient and effective emergency care.

Full addressee: Commissioners

Rec 18 Trusts; Commissioners

Trusts and commissioners to ensure high-quality coding and costing of clinical activity.

Rec 19 CQC

The Care Quality Commission to review and report on Emergency Care Data Set data quality as part of all their ED inspections.

Full addressee: CQC

Rec 20 Trusts

Trusts to invest in the facilities and opportunities for staff by adopting the priorities and values of the NHS People Plan.

Rec 21 HEE; NHS England and NHS Improvement; NHS Employers

Health Education England, NHS England and NHS Improvement, and NHS Employers to collaboratively address the underlying human resource issues.

Rec 22 NHS England and NHS Improvement; Trusts; Commissioners

NHS England and NHS Improvement should support trusts and systems to consider capital funding for their ED(s), with a view to ensuring that every trust has an ED(s) with an appropriate physical environment. This would enable the provision of high quality patient care and allow a good working environment for staff.

Rec 23 Trusts

All EDs to be configured to comply with infection prevention and control requirements.

Rec 24 Trusts

Trusts to ensure that ED hardware and software is purchased, developed and revised to enable clinical staff to work efficiently and effectively, without loss of productivity.

Rec 25 RCEM

The Royal College of Emergency Medicine to benchmark the usability of IT systems to enable trusts to make informed choices prior to procurement.

Rec 26 GIRFT; NHS England and NHS Improvement; RCEM

GIRFT to work with NHS England and NHS Improvement and the Royal College of Emergency Medicine to develop and publish a list of standard drugs to be automatically available to ED teams without the need for local applications. (This has already been achieved with the list of required antidotes.)

Rec 27 Commissioners; Trusts

Trusts to review their ED-attributed litigation, to identify recurrent themes and to take action accordingly.

Rec 28 Commissioners; Trusts

Commissioners and providers to ensure 24-hour availability of urgent cross-sectional imaging (both computed tomography and magnetic resonance scanning), rapid reporting of imaging and senior clinical advice to reduce patient harms.