Taking the pressure off A&E
THE Great Western Hospital is celebrating three years since the launch of a service which has seen patients examined more swiftly and efficiently away from the busy emergency department.
The ambulatory care unit was created in summer 2011 in a bid to ease pressure on A&E and allow people attending or referred to the emergency unit by their GPs and considered at lower risk to be seen by an acute care team for tests in the Kingfisher ward.
The new service aimed to cut waiting times, which due to increasing demand exceed the required four hours, by identifying those with less serious conditions and allowing them to be seen more promptly and to undergo the necessary scans in the space of a day.
Until then patients were examined in order of attendance which had led to some being kept overnight if they needed to have more tests the following day.
The service, which sees 300 people with a range of ailments from asthma or heart failure to pneumonia each month has allowed the GWH to cut emergency patients’ average stay by a day.
“The goal was to ease pressure on A&E and the bed base,” said Dr Ijaz Ahmed, consultant acute physician.
“We wanted to make the flow easier in A&E and allow them to achieve their four-hour target and to stop patients unnecessarily staying overnight.
“We filter 25/30 per cent to the unit who are well enough and can be managed in a day basis. That’s about 60 or 70 admissions a day.
“If people are well enough to be managed in an ambulatory setting, if they are deemed low risk, they would be referred up to the unit by A&E or if there is a diagnosis or test that can be delivered within this department within that day. We have treadmills, heart scans, we offer ECGs, chest X-rays and CT scans.
“GPs can also call us directly, if they already know a patient doesn’t need an ambulance but needs care.
“It’s speeding the process and it’s a better patient experience.
“Prior to the ambulatory care there used to a reflex decision to keep patients in overnight if they needed more test.
“But here they don’t have to stay overnight here and if it’s too late for a test to be done we could send the patient home and organise it for the next day.”
As pressure grows on the hospital to meet demand it is expected the service will expand and that most people referred to A&E by their GP will bypass the emergency unit stage altogether, unless their condition is too severe.
“We were one of the earlier hospitals to have this in place and this is becoming a national thing.
“The demand year on year for emergency medicine is increasing and the bed savings that we made in the last three years seem to have disappeared because of increased admissions.
“In the future, maybe three or four years down the line we eventually want patients deemed suitable for ambulatory care referred by GPs to come directly to and have an assessment through an ambulatory setting.”
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