News

Hands-on senior clinicians in A&E ‘could reduce demand’

Report says when consultants are in the emergency department to assess patients, there is less replication of work and decisions about next steps are made more quickly
Emergency departments

Having senior clinicians on hand to assess emergency department patients and collaborative working have a transformative effect on patient demand, according to a new report.

The Winters Tale report uses the views of staff to offer a snapshot of so-called winter pressures in 2016-17, and aims to identify the leadership secrets of high-performing emergency department teams.

It says when consultants are in the emergency department to make immediate patient assessments, replication of work is reduced and decisions about next steps can be made quickly.

One unnamed London trust that adopted this approach now reports sending 60-70 adults a day or about 30% of patients who present at A&E back into the community.

Clinical confidence

Having senior clinicians on hand to assess emergency department patients and collaborative working have a transformative effect on patient demand, according to a new report.


The report aims to identify the ‘leadership secrets’ of effective emergency department teams. Picture: iStock

The Winter’s Tale report uses the views of staff to offer a snapshot of so-called winter pressures in 2016-17, and aims to identify the ‘leadership secrets’ of high-performing emergency department teams.

It says when consultants are in the emergency department to make immediate patient assessments, replication of work is reduced and decisions about next steps can be made quickly.

One unnamed London trust that adopted this approach now reports sending 60-70 adults a day – or about 30% of patients who present at A&E – back into the community. 

Clinical confidence

The Institute of Healthcare Management conducted interviews with emergency department staff and managers at trusts across England to identify departments that were working well.

The institute’s chief executive Jill De Bene said: ‘When experienced staff see the patient first and make the big judgement calls, the positive impact for everyone involved is unquestionable. You need someone in A&E who has the clinical confidence to say no to someone whose problem should be dealt with elsewhere in the system.’

On average, consultants took four minutes to reassure patients they were safe to go home.

Ms De Bene said: ‘Transformational change is possible, even in the most challenging of times, through strong, effective management and collaborative working.’

Advanced practice nurses

RCN professional lead for acute, emergency and critical care Anna Crossley said advanced practice nurses also had an important role to play in assessment in emergecny departments.

‘Many senior nurses will be able to redirect patients to urgent care centres, out-of-hours GP services and walk-in centres – if these are available on a hospital site,’ said Ms Crossley. ‘It is about having someone senior enough to take decisions for discharge.’

Ms Crossley said most places understand there is not only one way of seeing and treating patients, and streaming people to the right staff would make processes more effective.

‘Ownership’

The report highlighted the importance of effective collaboration between clinicians and managers, integrated care and ‘ownership’ by other deparments of what is happening in the emergency deparment. 

‘A lot of people think meeting the four-hour wait target is entirely A&E’s business, but it is everybody’s role to obtain that target,’ she said.

Ms Crossley warned the ‘elephant in the room’ was staffing. ‘You still need a core set of nurses who are able to do the tasks of an emergency department nurse and deliver high quality care with a range of skills,’ she said. ‘A&E is haemorrhaging nurses with knowledge and experience and they are who we need.’


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