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Unscheduled Care Review

Improving waiting times in our emergency departments

Emergency department performance in NHS hospitals is regularly in the spotlight and for good reason.

A key indicator of the quality of care an emergency patient receives is the speed in which they undergo a medical assessment and have their condition diagnosed and treatment commenced.

Lengthy waits in an emergency department can cause potential risks to clinical safety.

Our staff have been working hard to tackle unscheduled care performance to achieve a sustained position where all patients can be seen, treated and admitted or discharged quickly.

We have seen significant improvements in our four-hour performance in recent months.

Despite these efforts – both at the front door and further downstream in our wards – we have continued to experience fluctuations in performance.

It was therefore agreed that we would carry out a ‘root and branch’ review of unscheduled care within NHSGGC. Known as the Unscheduled Care Programme, the work began in June and will continue through the winter.

In these pages we’ll keep you informed of progress with this programme of work.

Who is involved

The Unscheduled Care Programme is overseen by a Programme Board chaired by Robert Calderwood, Chief Executive.

Deputy medical director, Dr David Stewart, has been appointed to lead the programme, supported by a small project team.

He and the team, Alison Noonan and Mark Rodgers, are working closely with the sectors and with public health and e-health colleagues to identify practical, well planned projects that will tackle bottlenecks and deliver improvements, where appropriate building on work already underway at each of the main acute sites.

The detail of the governance structure of the programme is available in Board paper 16/46.

What is involved

A number of work-streams have been set up to identify priority areas for improvement throughout the patient pathway in unscheduled care from GP referral to discharge.

These are:

  • Analysis of demand, flows and resources: comprehensive analysis , the effectiveness of our service responses, source of referrals, nature of presentations and alternatives available to patients.
  • Assessment Processes: with increasing demand we must ensure that our assessment processes are fully effective and equitable – this will include improved use of Ambulatory Care and the provision of rapid access Clinics as an alternative to admission. An important priority is move as much unscheduled care onto a scheduled basis when clinically appropriate.
  • Inpatient Flow Processes: develop existing programme of improvement work to reduce delays in the system and optimise capacity over the 24 hour period.
  • Integrated Facilities Processes: develop programme of integrated work to understand bottlenecks and service constraints.
  • Scottish Ambulance service: develop programme of joint work with Scottish Ambulance Service around admission avoidance and better scheduling of care.
  • Interface with GPs: identify key issues in interface with GPs.
  • Work with Health and Social Care Partnerships: establish an agreed programme of work which will be led by HSCPs.
  • Develop a matrix for performance improvement: we need to understand and address variation.