Policy briefing

Emergency and acute medical care in over 16s guidance

New guidelines from National Institute for Health and Care Excellence cover organising and delivering emergency and acute medical care for people aged over 16

New guidelines from National Institute for Health and Care Excellence cover organising and delivering emergency and acute medical care for people aged over 16 – in support of the NHS Next Steps on the Five Year Forward View 


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Essential information

Emergency departments (EDs) are struggling with increasing demand, leading to pressure on staff and longer waits for patients and ambulances. Hospitals have found it increasingly challenging to maintain the flow of patients through from admission to discharge.

The NHS Next Steps on the Five Year Forward View, published in March 2017, stated that up to three million ED visits could have been better dealt with elsewhere. There are difficulties in admitting sicker patients into hospital beds and discharging them promptly back home. This document pledged to provide more alternative options to ED, to relieve pressure on the front door of hospitals and free-up beds.

What’s new

Advanced training to paramedics and providing community alternatives to hospital care could reduce admissions, according to new guidance. The document from the National Institute for Health and Care Excellence (NICE) looks at interventions that avoid hospital admission and facilitate earlier discharge to ease pressure on EDs.

The guideline, which covers organising and delivering emergency and acute medical care for people aged over 16, supports the NHS Next Steps on the Five Year Forward View.

It calls for ED staff to use a validated risk tool to inform decisions on whether to admit people for medical emergencies, and to provide access to liaison psychiatry services for people with medical emergencies and mental health problems.

People needing hospital admission with undifferentiated medical emergencies should be assessed in an acute medical unit. Discharge planning should begin at the time of admission for a medical emergency.

All patients should have a medical consultant review within 14 hours of admission, and daily reviews subsequently.

The guidance also calls for more nurse-led care in the community for those who have had or are at risk of a medical emergency, and specialist multidisciplinary community palliative care.

Implications for nurses

Support access to other professionals, including pharmacists, psychiatrists and occupational therapists, in the ED and medical admissions unit.

Start discharge planning as soon as a patient is admitted ensuring they can leave hospital promptly.

Use a validated tool recommended by NICE, such as the Glasgow Blatchford score for upper gastrointestinal bleeding and the CURB-65 score for community-acquired pneumonia in adults, along with clinical judgement when assessing patients for admission.

Use structured handovers and standardised systems of care such as checklists when patients are transferred from ED.

Expert opinion

Sara Morgan, matron and head of clinical services at the Spire Cambridge Lea Hospital

‘The guideline looks at a system-wide approach to delivering good, effective and efficient emergency care for acute medical emergencies. It makes clear that the pressures on emergency departments (EDs) cannot be solved just by the staff in these departments. Acute medical emergencies don’t belong just to the ED, but to the whole health system. For emergency nurses, the guidance looks at the importance of working across the multi professional team, such as bringing in physios, pharmacists and occupational therapists.

‘The guidance could help any emergency nurses who are trying to state the case for a multidisciplinary approach in an ED and the medical admissions unit. Most EDs probably have some elements of these recommendations in place but I don’t think there is anywhere where they are all implemented.

‘Fully implemented, the guidance could help make the patient pathway smoother and ease pressure on staff. There is a real shortage of robust evidence on interventions that can help ease pressure on EDs, and this is something emergency nurses could help with.’

 

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