Ambulatory Care

Summary of document:

Within Stockport we admit many more people to hospital than similar areas across Greater Manchester and England. This is generally driven by the number of admissions of people with conditions which are defined as ‘ambulatory care sensitive’ (ACS). This means people who have conditions which could be managed in a community setting to help them avoid needing to be admitted to hospital, such as an asthma attack.

In Stockport we also face a number of challenges in meeting national waiting time standards within the Emergency Department (also known as A&E). This is due to a lack of an effective process to triage people (i.e. make sure they’re seen by the most appropriate department, professional or team).

This business case proposes changing the way the A&E department is set up in three ways:

  1. Introducing a more senior triage capability.
  2. Introducing an Ambulatory Illness (AI) team.
  3. Creating a larger, more defined Ambulatory Care Unit (ACU).

Through this, the aim is to reduce the number of people seen in the A&E department by 500 people per week, and to reduce unnecessary emergency admissions of people with ACS conditions by 40 a week.

This proposed way of working will strengthen the triage process by improving the availability of senior decision makers within the team. This will include having primary care expertise within the department (for example, having a GP in A&E), access to patients’ electronic record (with appropriate safeguards), and improving the decision making protocols and processes.

Behind A&E triage there will be a new service operating 8am to midnight 7 days a week to deal with peak periods of demand. It will meet the needs of people who do not require full A&E services, but may need some lower level support (for example reassurance about a rash). It is estimated this primary care led service will see more than 300 people a week, leaving A&E staff free to work with people with more serious needs more promptly.

There is an existing Ambulatory Care Unit but currently it only opens for limited hours. This business case proposes increasing the capacity and opening hours so that it will go from seeing 160 people a week to seeing 350 people a week and be open 8am to midnight 7 days per week. This unit will diagnose, treat, stabilise and discharge people home where their condition does not require overnight hospital care, but does need short-term medical input.

The increase in capacity, along with a combination of access to GP records for the clinical team, changes to the way that patients move through the emergency care services and dedicated specialist staff and equipment, will reduce admissions through A&E by 40 people a week.

More importantly it will ensure people who need brief medical help are treated quickly and are able to return home safely rather than being admitted unnecessarily. The opening hours reflect the known period of demand.

These services have already been implemented in a trial form as part of the plans to address local A&E challenges. This business case describes why these developments should be continued and the funding required to make this happen going forward. In this regard the contribution to improving A&E performance is a significant planned benefit as well as the financial and patient benefits described above.