Abstract
Introduction: Ambulatory Emergency Care (AEC) patients have care requirements that exceed community provisions for investigation or treatment. Same Day Emergency Care (SDEC) is an alternative descriptor term. The aims of this study were twofold: To assess the current SDEC activity being provided by Physicians. To assess for potential increased efficiencies.
Methods: A 13-day review of the AEC area of the Emergency Department (ED) was performed. During the study period, a total of 2,083 patients attended the ED. Of these, 687 patients (33%) attended the AEC area, 73% of whom were seen by physicians.
Results:
The average patient age was 48 years. 63% of patients were self-referrals and 37% were primary care referrals.
Out of those patients who were primary care referrals, 23% were admitted. Of those who were self-referrals, 12% were admitted.
45% patients had no imaging performed, 35% had X-Ray, 14% had C.T and 5% Ultrasound.
Mean time from registration to clinical review was 2 hours 15mins.
For discharges, all were processed within 3 hours from start of clinical review. For patients referred for admission, all were processed by the ED within 4 hours from start of clinical review.
The main presentations were non-fracture musculoskeletal (MSK) complaints, next general medical presentations followed closely by general surgical presentations.
Conclusion: It is important that AEC is recognized as a distinct service within the ED. Its staffing needs to be protected. Similarly, it needs dedicated physical space which suits its activity as well as prompt access to diagnostics.
Collaboration with other specialties has led to the development of SDEC pathways for a diverse range of conditions such as Hematuria, Urinary Retention, First Seizure, Spontaneous Pneumothorax, Anaphylaxis, Venous Thromboembolism, Post exposure Prophylaxis, Cellulitis, Falls and Syncope and Inclusion Health. These work to avoid admissions and facilitate timely outpatient follow-up.
Further pathways under development are a pyelonephritis pathway and a breast care pathway.
The AEC Area sees patients across the full spectrum of presentations. As such, it is essential that senior physician presence is maintained and strengthened in the delivery of AEC.
It is important that we continue to develop advanced roles for Nurses and Therapy Professionals who can autonomously see patients with support from their physician colleagues when required. This is demonstrated by the majority of cases being in the non-fracture MSK group who would be suitable for Advanced Nurse Practitioner or Advanced Practice Physiotherapy assessment.
The large proportion of general medical and surgical cases is an area in which we have developed an Ambulatory Care Advanced Nurse Practitioner role. This role is gradually being expanded to an increasing number of presentations and includes signposting to different healthcare environments to reduce duplication and resource waste, for example direct to a maternity or eye hospital where indicated.
In the future, the reach of Cardiology ANPs could also be extended to the AEC Area in the reduction of Heart Failure and New Atrial Fibrillation admissions.
With 17% of ambulatory patients being over 70 years of age, we are actively developing a Geriatric Emergency Medicine service.