> In Oxfordshire we had a 26% increase in patient numbers
> presenting to the ED
> during the second week of September compared with the same
> period last year.
>
> Over the last 6 months our numbers are up 13%.
>
> We are looking in detail at the case mix but certainly out of
> hours are
> primary care case mix is certainly up.
Broadly 20%. Case mix pretty much across the board. I'd have expected maybe
an increase in Primary Care attendances (although our current Out of Hours
activity is pretty much the same as the co-ops had before they finished),
and an increase in minor injuries (as this is not part of the core
contract). There certainly was an increase in some primary care conditions
(particularly diarrhoea and vomiting, abdominal pain, mental illness and
dental problems); but the conditions making up the biggest parts of our
overall increase were mainly trauma. The interesting thing about the
increase in trauma was that the percentage rise in confirmed fractures was
about the same as the overall rise in trauma (in other words, if this was
due to GPs passing minor injuries to A and E, they were missing a lot of
fractures before) . Interestingly, once the out of hours kicked in, we had a
modest decline in emergency admissions. It may be that now that the sessions
are voluntary, those GPs choosing to do them are the one who enjoy emergency
work more (and I'd expect people enjoying a particular aspect to tend to be
better at it).
> With the best will in the world, I'm not sure if trained
> nurses will be
> able to deal with all these enquiries as effectively without
> recourse to
> experienced primary care medics. Same argument goes for paramedic
> practitioners in community.
>
> Will A&E become, by default, the "medical backup" for the less
> straightforward cases?
Might be. Better to do it by agreement than by default. What we've gone for
is GPs up until 11 pm. GPs don't want to do the overnight shift, so we've
been funded for additional staff grades to cover that period. Seems to work
pretty well.
Remainder of post is mostly relatively off the wall ideas that might be
worth considering, but I'm not sure whether they'd be workable.
> "Does anyone have a protocol for A&E at triage to refer
> patients directly to
> the GP out of hours service?"
>
> If not, what if the patients in the Triage Category Green or
> Blue who had
> not had an accident, RTA, self harm or assault (ref patient
> group) were
> re-directed to the GP service?
One system we were looking at was all "accidents" and "emergencies" (injury
within last 48 hours; acute onset pain or new physiological disturbance)
were A and E; others for assessment by GP services first as with other
specialities. I think in NELHEC, there is some stuff from Coventry (drop in
primary care is close to A and E) on triage from A and E to primary care.
> What we would like is to be able to offer patients a specific
> time to be seen in ED, so that they do not wait for 2-4
> hours, but arrive at a specific time, as they do at the PCC.
Although one could argue that anything needing an appointment isn't an
emergency. That said, one thing we're considering- given that it is easier
to get staff to work office hours and that there is limited availability of
some backup services out of hours- is giving certain stable minor injuries
office hours or near office hours appointments when we can lay on an extra
radiographer, and we've got quick and easy access to ultrasound, consultant
orthopaedic surgeons, consultant radiologists, physios, OTs etc.
Matt Dunn
Warwick
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