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March 2, 2020

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Reducing pressure on A&E – How we can make a difference

By Uko Umotong, National Discharge and Community Services Manager

This winter, we have heard a lot about the pressures on A&E and the consequent impact on patients including record waiting lists for routine operations and delays in finding beds for the sickest patients.

During December and January, nearly a quarter of patients in A&E faced delays of more than four hours before transfer to a ward. And, one in seven of all patients brought in by ambulances had to wait over 30 minutes before being seen by hospital staff1.  In addition, patients were also struggling to leave hospital. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years2.

There are now mounting concerns that a mass outbreak of coronavirus in the UK would further exacerbate the situation. In fact, delaying the outbreak to avoid winter pressures in the NHS has become a key part of the UK’s strategy to contain the disease and avoid additional pressure on the NHS.

Clearly, helping to ensure that patients leave hospital as soon as they are medically fit should be a priority. But equally, we need to make sure that older people in care homes do not attend A&E when the right care can be provided in the community.

We’ve been working with NHS partners applying our specialist skills around discharge and understanding of local care provision to reduce the volume of patients attending A&E from care homes. And at the same time, we support hospitals to reduce the length of stay of those who are admitted to hospital.

How have we been making this happen?

  • Getting patients assessed by care homes more quickly: care homes come and assess patients as soon as they are fit to leave hospital. This reduces the time patients wait in hospital.
  • Working with community services and acute flow managers: deploying existing services and support to help ensure residents, especially those who are High Intensity Users (HIUs) of A&E, can stay out of hospital.
  • Providing extra support and care for older people returning to their care home: ensuring additional help, such as falls and frailty services, are being deployed appropriately so that older people avoid additional visits to A&E.
  • Helping acute services to understand the care that can be provided in nursing homes: for example, if they are able to manage IV antibiotics or tracheotomies, allowing residents to return home for their recovery.
  • Working closely with care homes producing a high volume of A&E attendance: bringing them together with acute colleagues to understand issues and provide solutions to reduce this pressure.

The challenge of maintaining patient flow when there is unprecedented demand is not easy. We want to help people get the right care, in the right place at the right time by working together with colleagues in the community and acute settings.  We’re pleased to see this new service make a difference and we’re keen to do more.

1https://www.bbc.co.uk/news/health-51565492

2 https://www.theguardian.com/society/2020/feb/23/bed-blocking-highest-since-2017-hospitals-nhs

As originally seen on LinkedIn

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