A&E and Acute Medicine
The other crucial parts of the hospital trust urgent care system are acute medicine, surgery and orthopaedics. The acute trust receiving and assessment function of these departments should be seamlessly integrated with the A&E majors or non ambulatory process. Trusts and local commissioners should agree a set of process and quality metrics which ensure patients are assessed rapidly by senior staff after arrival and then have rapid access to appropriate diagnostics followed by a senior decision within a 2-3 hour window for the whole episode. The outcomes after this process will be a range of local options. What is not in doubt is that rapid senior assessment and treatment results in improved outcomes. The range of quality metrics should focus on clinical processes and outcomes.
In addition, the acute trust should ensure there is a positive and clinical dialogue between admitting doctors and the senior receiving doctor at the point of referral. For too long the process of admission has been reduced to an administrative process via a bed bureau. The improved process will allow a more sensitive and appropriate plan to be developed for the patient in advance of arrival at the hospital and indeed may allow the utilisation of alternatives such as rapid out patients or community and ambulatory based alternatives to admission.
The relationship between the emergency department and the rest of the hospital is a crucial interface in the urgent and emergency care pathway and tends to be put under particular strain when the emergency department is under pressure or struggling to treat people rapidly.