Rates of emergency admission have been rising for some time in the UK and there is significant concern around the degree to which the system is being stretched. Over the past few years, doctors and managers have been looking for ways to reduce emergency admissions without compromising the quality of patient care.
Ambulatory emergency care allows patients going to hospital as an emergency to be quickly assessed, diagnosed and treated on the same day, so that they can return home, reducing the number of patients admitted to a hospital bed. Although not suitable for all patients, for example those needing emergency surgery, the streamlined process has already improved clinical care, reduced costs, and is popular with patients. It is particularly useful for older, frail patients who will recover better in their own home.
This new toolkit from the Royal College of Physicians outlines the principles of AEC and describes the resources required for delivering AEC, highlighting the benefits, and signposts other resources to support its development.
Effective implementation requires a whole system approach to include primary care, community and ambulance services working with the acute site to establish patient pathways. The toolkit sets out 11 principles to be followed to ensure the success of AEC, the four emerging models of AEC, and practical tips on setting up an AEC service. It includes the four questions that should be asked to determine whether or not a patient is suitable for AEC, and underlines the importance of sharing information about the patient between hospitals, GPs and social care so that the patient's care after leaving hospital that day isn't compromised by missing information.
Dr Vincent Connolly, co-author of the toolkit and consultant in diabetic medicine, South Tees Hospitals NHS Foundation Trust, said:
'Ambulatory Emergency Care is a new paradigm in emergency care, it enables clinical teams to focus on providing care for patients without the need for formal admission to a bed. We are delighted that the RCP has developed this toolkit which will support the social movement that is transforming emergency care.'
Deborah Thompson, co-author of the toolkit and Programme Director, Ambulatory Emergency Care Delivery Network, said:
'The creation of this toolkit has enabled us to distil learning from many sites across England. Using principles within this toolkit clinical teams will be able to rapidly develop and improve AEC services, maximising this approach as a real alternative to overnight admission to hospital for the benefit of patients and staff alike.'
Dr Frank Joseph, RCP Acute Care Fellow and acute care toolkit series editor, said:
'The challenges faced by acute services require change to provide new ways of caring for the acutely unwell. Recognition that traditional services and ways of delivering care are not entirely fit for purpose and are unsustainable has led to innovation that seeks to deliver quality, patient centred acute care of which ambulatory emergency care is a prime example.'
The toolkit is free to download from the RCP website: https://www.rcplondon.ac.uk/ACT10