Download Urgent and Emergency Care Service Specifications

Urgent and Emergency Care
Service Specifications
May 2015
Urgent, Emergency, and Specialist care centres – Service Specifications v1
12/05/2015
Urgent and Emergency Care Service
Specifications
Introduction
These outline specifications describe the characteristics of facilities providing urgent and
emergency care services in London. They stem from the Keogh review Phase 1 report which
called for clarity and transparency about what services different facilities offer and put forward
Urgent Care Centres (UCC), Emergency Centres (EC) and Specialist Emergency Centres (SEC)
as terminology to articulate such services. High level overviews of these are outlined in the table
below.
In London, stakeholders have proposed that the London quality standards for urgent and acute
emergency services should be integral to the service specification criteria, in addition to a
number of national and London specialty provision guidance.
Overview of the facilities
Urgent Care Centres
Emergency Centres
Specialist (Major)
Emergency Centres
 Community-based primary
care facilities providing
urgent care for a local
population.
 Encompass Walk-in
Centres, Minor Injuries
Units, GP-led Health
Centres and all other
similar facilities – but now
referred to as Urgent Care
Centres
 Consistent in their service
provision and available 24
hours, 7 days per week.
 Where appropriate, colocated with emergency
centres on hospital sites
 Hospital based facilities
able to receive a full range
of emergency patients, of
all ages
 Provide for the reception,
resuscitation, diagnosis,
treatment and onward
referral.
 The initial receiving
destination for almost all
emergency and ambulance
patients
 Entire facility is designated
as an Emergency Centre,
including the Emergency
Department that is located
within it.
 Hospital based facilities with
all the features of an EC, but
also specialist facilities that
receive patients from ECs,
or directly from an
ambulance which has
bypassed an EC.
 Larger units, capable of
assessing and initiating
treatment for all patients and
providing a range of
specialist services
 Entire facility is designated
as a Specialist Emergency
Centre, including the
Emergency Department that
is located within it.
2
Facilities Service Specifications
Urgent Care Centres
Domain
Specification
1. Governance
i. Each urgent care centre is to have a formal written policy for
providing urgent care. This policy is to adhere to the urgent care
clinical quality standards. This policy is to be ratified by the service’s
provider board and the U&EC Network annually.
ii. All urgent care centres are to be within an urgent and emergency
care network.
iii. Co-located and standalone centres to have integrated clinical
governance structures with Emergency centres.
iv. All patient safety incidents should be reported to the National
Reporting and Learning System and reviewed locally to identify and
implement learning. Similarly all National Patient Safety Alerts should
be implemented in full and in the spirit they are intended.
Reference
i. Urgent care LQS 1
ii. (Based on) Urgent
care LQS 2
iii. (Based on) Urgent
care LQS 2
iv. Urgent care
National draft
standards 18
v. Addition
v. All patients attending urgent care centres are able to access the
same integrated clinical pathways as if they had attended an
Emergency Centre.
2. Location
i. Community-based primary care facilities providing urgent care for a
local population.
ii. Where possible, co-located with emergency centres on hospital sites.
i. Developing U&EC
facilities
specifications guidance document
ii. Developing U&EC
facilities
specifications -
Points for
discussion
Should this
specification be
applied to
individual
facilities or across
a number of
facilities across a
network or SRG
footprint to
ensure
affordability
particularly in
relation to:
-
Opening hours
-
Medical cover
-
Diagnostics
Report name and version
date month year
guidance document
3. Operating
hours
i. Consistent in their service provision and available 24 hours, 7 days
per week.
i. Developing U&EC
facilities
specifications guidance document
Should the
specification,
particularly 24/7,
apply to all urgent
care facilities or
for a network to
ensure coverage
of facilities in a
defined region?
4. Staffing
i. During the hours that they are open all urgent care services to be
staffed by multidisciplinary teams, including: at least one registered
medical practitioner (either a registered GP or doctor with appropriate
competencies for primary and emergency care), and at least one
other registered healthcare practitioner.
i. Urgent care LQS 3
Does the board
support that all
facilities require
this level of
staffing?
ii. Urgent care LQS 14
iii. Urgent care LQS 16
ii. All registered healthcare practitioners working in urgent care services
to have a minimum level of competence in caring for adults, and
children and young people (where the service accepts children),
including: (a) Basic life support; (b) Recognition of serious illness and
injury; (c) Pain assessment; (d) Identification of vulnerable patients At
anytime the service is open at least one registered healthcare
practitioner is to be trained and competent in immediate life support
and paediatric immediate life support, where the service accepts
children.
iii. Urgent care services to have arrangements in place for staff to
access support and advice from experienced doctors (ST4 and above
or equivalent) in both adult and paediatric emergency medicine and
other specialties without necessarily requiring patients to be
transferred to an emergency department or other service.
2
Healthy London Partnership
Report name and version
5. Assessment
& Treatment
date month year
i. An escalation protocol is to be in place to ensure that seriously ill/high
risk patients presenting to the urgent care service are seen
immediately on arrival by a registered healthcare practitioner.
i. Urgent care LQS 4
ii. Urgent care LQS 5
iii. Urgent care LQS 6
ii. All patients are to be seen and receive an initial clinical assessment
by a registered healthcare practitioner within 15 minutes of the time of iv. Urgent care LQS 7
arrival at the urgent care service.
iii. Within 90 minutes of the time of arrival at the urgent care service 95
per cent all patients are to have a clinical decision made that they will
be treated in the urgent care service and discharged or arrangements
made to transfer them to another service.
iv. At least 95 per cent of patients who present at an urgent care service
to be seen, treated if appropriate and discharged in under 3 hours of
the time of arrival at the urgent care service.
6. Diagnostics
i. Access to minimum key diagnostics during hours the urgent care
service is open, with real time access to images and results:
-
Plain film x-ray: immediate on-site access with formal
report received by the urgent care service within 24 hours
of examination
-
Blood testing: immediate on-site access with formal report
received by urgent care service within one hour of the
sample being taken
i. Urgent care LQS 10
Should this level
of access to
diagnostics apply
to all urgent care
facilities or for a
network to ensure
access across a
defined region?
Clinical staff to have the competencies to assess the need for, and
order, diagnostics and imaging, and interpret the results. [It is
suggested that a cost-benefit analysis be undertaken by each service
prior to implementation].
7. Equipment
i. Appropriate equipment to be available onsite:
-
a full resuscitation trolley
an automated external defibrillator
i. Urgent care LQS 11
ii. Urgent care LQS 12
3
Healthy London Partnership
Report name and version
date month year
-
oxygen
suction and
emergency drugs
All urgent care service to be equipped with a range of medications
necessary for immediate treatment.
ii. LQS 12 - Urgent care services to have appropriate waiting rooms,
treatment rooms and equipment according to the workload and
patient’s needs.
8. Mental
Health
i. Single call access for mental health referrals to be available during
hours the urgent care service is open, with a maximum response time
of 30 minutes.
ii. Dedicated area for mental health assessments which reflects the
needs of people experiencing a mental health crisis.
iii. Arrangements in place to ensure Mental Health Act assessments
take place promptly and reflect the needs of the individual concerned.
Should this be in
place at every
ii. - vi. London Mental
UCC or a robust
Health Crisis
pathway in place
standards and
Mental Health Crisis to access this?
Care Concordat
i. Urgent care LQS 17
iv. Access to all the information required to make decisions regarding
crisis management including self-referral.
9. Transfer
i. All patients to have an episode of care summary communicated to
the patient’s GP practice by 08.00 the next day. For children the
episode of care is to be communicated to their health visitor or school
nurse, where known and appropriate, no later than 08.00 the second
day.
ii. All registered healthcare practitioners working in urgent care services
to have direct access to urgent referrals to specialist on-call services
when necessary, and the right to refer those patients who they see
within their scope of practice.
i. Urgent care LQS 13
ii. Urgent care LQS 15
iii. London Inter
hospital transfer
standards
iii. To adhere to the inter hospital transfer standards http://www.londonhp.nhs.uk/services/quality-and-safety4
Healthy London Partnership
Report name and version
date month year
programme/inter-hospital-transfer-and-acceptance-standards/
10. Patient
information
i. All Urgent Care Centres should have arrangements in place for staff
to access an up-to-date electronic patient care record.
ii. During all hours that the urgent care service is open it is to provide
guidance and support on how to register with a local GP.
11. Patient
experience
i. Patient experience data to be captured, recorded and routinely
analysed and acted on. Data is to be regularly reviewed by the board
of the urgent care provider and findings are to be disseminated to all
staff and patients.
i. Urgent care
National draft
standards 13
ii. Urgent care LQS 8
i. Urgent care LQS 18
ii. Urgent care LQS 19
iii. Urgent care LQS 20
ii. All patients to be supported to understand their diagnosis, relevant
treatment options, ongoing care and support by an appropriate
clinician.
iii. Where appropriate, patients to be provided with health and wellbeing
advice and sign-posting to local community services where they can
self-refer (for example, smoking cessation services and sexual
health, alcohol and drug services).
12. Training
i. Urgent care services to provide appropriate supervision for training
purposes including both educational supervision and clinical
supervision.
ii. All healthcare practitioners to receive training in the principles of
safeguarding children, vulnerable and older adults and identification
and management of child protection issues. All registered medical
practitioners working independently to have a minimum of
safeguarding training level 3.
i. Urgent care LQS 21
ii. Urgent care LQS 22
Should the need
for an integrated
system in relation
to training be
specified or
should this be
part of the
network
specification?
5
Healthy London Partnership
Report name and version
date month year
Emergency centres
Domain
1. Governance
Specification
i. All Emergency Centres must be part of an identified U&EC
Network, with integrated governance structures.
ii. Every Emergency Centre should have a formal written policy for
providing emergency care, and clear pathways of care, including
acceptance and referral criteria, for all common emergency
conditions within the over-arching Strategic Network. This policy
includes both physical and mental health, and will be ratified by
the service’s provider board and the U&EC Network annually.
2. Location
3. Operating
hours
4. Staffing
Reference
i. Emergency care
centre National
draft standards 1
ii. Emergency care
centre National
draft standards 2
i. Emergency Centres must contain an Emergency Department that
operates structurally and functionally within a supporting acute
hospital.
i. Developing U&EC
facilities
specifications guidance
document
i. Consistent in their service provision and available 24 hours, 7
days per week.
i. Developing U&EC
facilities
specifications guidance
document
i. Under the continuous supervision and accountability of one or
more consultants in Emergency Medicine.
i. Developing U&EC
facilities
specifications –
guidance
ii. A trained and experienced doctor (ST4 and above or doctor of
equivalent competencies) in emergency medicine to be present in
the emergency department 24 hours a day, seven days a week.
iii. A consultant in emergency medicine to be scheduled to deliver
clinical care in the emergency department for a minimum of 16
hours a day (matched to peak activity), seven days a week.
Points for discussion
ii. Emergency
Department LQS 1
iii. Emergency
6
Healthy London Partnership
Report name and version
date month year
Outside of these 16 hours, a consultant will be on-call and
available to attend the hospital for the purposes of senior clinical
decision making and patient safety within 30 minutes.
Department LQS 2
iv. Emergency
Department LQS 6
iv. A designated nursing shift leader (Band 7) to be present in the
emergency department 24 hours a day, seven days a week with
provision of nursing and clinical support staff in emergency
departments to be based on emergency department-specific skill
mix tool and mapped to clinical activity.
5. Assessment/
Treatment
i. 95 per cent of patients will wait less than 4 hours from arrival to
admission, discharge or transfer.
i. Department of
health
ii. A clinical decision/ observation area is to be available to the
emergency department for patients under the care of the
emergency medicine consultant that require observation, active
treatment or further investigation to enable a decision on safe
discharge or the need for admission under the care of an
inpatient team.
ii. Emergency
Department LQS 5
iii. Emergency
Department LQS 7
iii. Triage to be provided by a qualified healthcare professional and
registration is not to delay triage.
6. Diagnostics
i. 24/7 access to the following minimum key diagnostics:
-
X-ray: immediate access with formal report received by
the ED within 24 hours of examination
-
CT: immediate access with formal report received by
the ED within one hour of examination
-
Ultrasound: immediate access within agreed
indications/ 12 hours with definitive report received by
the ED within one hour of examination
-
Lab sciences: immediate access with formal report
received by the ED within one hour of the sample
i. Emergency
Department LQS 3
7
Healthy London Partnership
Report name and version
date month year
being taken
-
Microscopy: immediate access with formal result
received by the ED within one hour of the sample
being taken
When hot reporting of imaging is not available, all abnormal
reports are to be reviewed within 24 hours by an appropriate
clinician and acted upon within 48 hours.
7. Equipment
8. Mental
Health
i. The Emergency Department must include a resuscitation area
with appropriate equipment to provide advanced paediatric, adult
and trauma life support prior to transfer to definitive care.
i. Emergency care
centre National
draft standards 3
i. Dedicated area for mental health assessments which reflects the
needs of people experiencing a mental health crisis.
i. – vi. London
Mental Health
Crisis standards
and Mental Health
Crisis Care
Concordat
ii. Have access to on-site liaison psychiatry services 24 hours a
day, 7 days a week.
iii. Liaison Psychiatry services to see service users within 1 hour of
ED referral
iv. Arrangements in place to ensure Mental Health Act assessments
take place promptly and reflect the needs of the individual
concerned.
v. Access to all the information required to make decisions
regarding crisis management including self-referral.
9. Transfer
i. Following initial stabilisation some patients who require specialist
care will be transferred to another Emergency Centre or a
Specialist Emergency Centre; this transfer capability is integral to
the functioning of an Emergency Centre and the network in which
it operates.
ii. Emergency department patients who have undergone an initial
i. Developing U&EC
facilities
specifications –
guidance
ii. Emergency
Department LQS 4
8
Healthy London Partnership
Report name and version
date month year
assessment and management by a clinician in the emergency
iii. Emergency
department and who are referred to another team, to have a
Department LQS 9
management plan (including the decision to admit or discharge)
iv. Inter hospital
within one hour from referral to that team. When the decision is
transfer standards
taken to admit a patient to a ward/ unit, actual admission to a
ward/ unit to take place within one hour of the decision to admit. If
admission is to an alternative facility the decision maker is to
ensure the transfer takes place within timeframes specified by the
London inter-hospital transfer standards (See below link).
iii. Timely access, seven days a week to, and support from, onward
referral clinics and efficient procedures for discharge from
hospital.
iv. To adhere to the inter hospital transfer standards http://www.londonhp.nhs.uk/services/quality-and-safetyprogramme/inter-hospital-transfer-and-acceptance-standards/
10. Clinical
support
services
i. Emergency departments to have a policy in place to access
support services seven days a week including: - Alcohol liaison Mental health - Older people’s care - Safeguarding - Social
services.
ii. Timely access, seven days a week to, and support from,
physiotherapy and occupational therapy teams to support
discharge.
11. Inpatient/
Elective
i. Adhere to the following London Quality Standards
-
Acute medicine and emergency general surgery http://www.londonhp.nhs.uk/services/quality-andsafety-programme/acute-medicine-and-emergencygeneral-surgery/
-
Critical care http://www.londonhp.nhs.uk/services/quality-and-
i. Emergency
Department LQS 8
ii. Emergency
Department LQS
10
i. Range of LQSs
ii. London clinical
dependency
framework
Does the Board
support the inclusion of
the London quality
standards and interdependency
framework as part of
this specification?
9
Healthy London Partnership
Report name and version
date month year
safety-programme/critical-care/
ii.
12. Patient
information
13. Patient
experience
-
Fractured neck of femur pathway http://www.londonhp.nhs.uk/services/quality-andsafety-programme/fractured-neck-of-femur-pathway/
-
Maternity services http://www.londonhp.nhs.uk/services/quality-andsafety-programme/maternity-services/
Adhere to the London clinical dependency framework http://www.londonhp.nhs.uk/services/quality-and-safetyprogramme/clinical-dependencies-framework/
i. IT system for tracking patients, integrated with order
communications. A reception facility with trained administrative
capability to accurately record patients into the emergency
department to be available 24 hours a day, seven days a week.
Attendance, and admission record and discharge summaries to
be immediately available in case of re-attendance and monitored
for data quality.
i. (Based on)
Emergency
Department LQS
11
i. Consultant-led communication and information to be provided to
patients and to include the provision of patient information
leaflets.
i. LQS
ii. Patient experience data to be captured, recorded and routinely
analysed and acted on. Review of data is a permanent item on
the trust board agenda and findings are disseminated.
14. Training
i. The emergency centre to provide a supportive training
environment and all staff to undertake relevant ongoing training.
i. LQS
10
Healthy London Partnership
Report name and version
date month year
Additional specifications for Specialist Emergency Centres
Specialist Emergency Centres will provide all the features of an EC, but also specialist facilities. These additions are outlined below.
Domain
Specification
Reference
1. Governance
i. Take lead responsibility for quality of care and operational
performance of service across its network.
i. Developing U&EC
facilities
specifications –
guidance
ii. Protocols across networks should be in place with London
Ambulance Service in regards to who should be conveyed to a
Specialist Emergency Centre.
2. Staffing
i. Provide staffing in line with agreed specialist service
specifications.
ii. Addition
National guidance
states that Specialist
Emergency Centres
should ‘contain
specialist facilities and
expertise’; in London it
is proposed that
Specialist Emergency
Centres include
HASUs, MTCs, and
Heart Attack Centres does the board support
the inclusion of these
specialist services in
the specification?
i. http://www.london
hp.nhs.uk/services
/major-trauma/
http://www.london
hp.nhs.uk/services
/stroke/
http://www.englan
d.nhs.uk/wpcontent/uploads/2
013/06/a09-cardi11
Healthy London Partnership
Report name and version
date month year
primpercutaneous.pdf
http://www.vascula
rsociety.org.uk/wpcontent/uploads/2
013/06/ServiceSpecification.pdf
3. Assessment/
Treatment
4. Diagnostics
5. Transfer
6. Specialist
care
a. Major
Trauma
b. Hyper-
i. Receive patients identified with specialist needs, either from
ambulances that have bypassed an Emergency Centre or
patients transferred from Emergency Centre in line with agreed
protocols.
i. Developing U&EC
facilities
specifications –
guidance
i. Provide24/ 7 immediate access to enhanced diagnostics such as
CT and MRI scanning and interventional radiology, and a wider
range of facilities.
i. Developing U&EC
facilities
specifications –
guidance
i. Transfer from a Specialist Emergency Centre will be rare, other
than for recovering patients being returned to community based
settings of care, closer to patients’ homes or based on agreed
protocols for specialist services.
i. Developing U&EC
facilities
specifications –
guidance
i. Contains one of more specialist facilities and expertise – likely to
fall within the remit of specialised commissioning(outlined below).
i. Developing U&EC
facilities
specifications –
guidance
i. Adhere to standards for Major Trauma Centres.
http://www.londonhp. Does the board
nhs.uk/services/major support the inclusion of
these specialist
-trauma/
services in the
http://www.londonhp. specification?
i. Adhere to standards for Hyper-Acute Stroke Units.
nhs.uk/services/strok
12
Healthy London Partnership
Report name and version
date month year
e/
Acute
Stroke
Units
c. Heart
Attack
Centres
d. Vascular
Centres
i. Adhere to standards for Heart Attack Centres.
http://www.england.n
hs.uk/wpcontent/uploads/2013
/06/a09-cardi-primpercutaneous.pdf
i. Adhere to standards for specialised vascular services.
http://www.england.n
hs.uk/wpcontent/uploads/2013
/06/a04-spec-vascuadult.pdf
13
Healthy London Partnership