Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Improving patient flow: setting up of an ambulatory care unit in Nevill Hall Hospital using the CORE role of the chief registrar

S Akhtar, M Brouns, D Wales and C Ward
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.17-3-s18
Clin Med June 2017
S Akhtar
Departments of Acute and Respiratory Medicine, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, Wales.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M Brouns
Departments of Acute and Respiratory Medicine, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, Wales.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
D Wales
Departments of Acute and Respiratory Medicine, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, Wales.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
C Ward
Departments of Acute and Respiratory Medicine, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, Wales.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Introduction

Ambulatory emergency care is an emerging streamlined model for managing emergency patients presenting to hospital who would otherwise be admitted.1 These radical patient-flow models have emerged in response to the continuing unprecedented rise in the number of emergency hospital attendances and subsequent admissions. The chief registrar, due to working on the front line, is centrally positioned to identify issues, promote collaboration and adopt examples of innovative practice. Nevill Hall Hospital (NHH) is a district general hospital with 165 adult medicine beds situated in Abergavenny, East Wales. It provides inpatient/outpatient care. However, it did not have an Ambulatory Care Unit (ACU) and this is where my project began.

Aim

Reduce the waiting time for medical patients to be seen by a consultant by 50% (6 hours) over a six-month period.

Methods

Prior to ACU, all GP medical and surgical referrals were assessed in the Emergency Assessment Unit (EAU). This consisted of 6 trolleys and a waiting area. EAU has 20 beds with an average of 30 medical admissions.

It was long recognised that medical patients presenting to EAU received sub-standard care with up to 40% waiting longer than the Royal College of Physicians (RCP) defined 14-hour target for consultant review.2

A key part of my chief registrar role was to examine and improve the waiting times for EAU Medical patients. The first step was opening an ACU using the RCP’s overarching principle: treat all emergency patients as ambulatory until proven otherwise.1

The ACU opened in late November 2016, it is a simple two-trolley unit with a waiting area and a consultant-delivered service, but with currently limited opening hours.

Results

Early data reveals appropriate patient selection as reflected by the high percentage discharge rate of greater than 80%. However, the impact on waiting times has been more variable with an overall reduction to 5.05 hours to discharge from 5.2, but this data does not include the waiting time of non-ambulatory patients.

Conclusion

The CORE framework is useful in ensuring the Future Hospital’s key principles of care are an integral part of innovative change. The chief registrar is uniquely positioned to lead and champion change, working both at the front-line and with senior clinicians/managers. Early data reveals that patients are being seen more efficiently, with significantly reduced waiting times, and increased appropriate discharges, resulting in an overall positive patient experience. However, significant work remains, with project phase two aiming to improve waiting times for non-ambulatory patients.

View this table:
  • View inline
  • View popup
Table 1.

Using the CORE chief registrar framework to positively and effectively influence change. Adapted from the Future Hospital’s 11 Principles of Care3

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Comparison of waiting times pre and post setting up the ACU.

  • © Royal College of Physicians 2017. All rights reserved.

References

  1. ↵
    1. Royal College of Physicians
    . Acute Care Toolkit 10: Ambulatory ­emergency care. London: RCP, 2014. www.rcplondon.ac.uk/guidelines-policy/acute-care-toolkit-10-ambulatory-emergency-care
  2. ↵
    1. Royal College of Physicians
    . Acute Care Toolkit 4: Delivering a 12 hour, 7 day consultant presence on the acute medical unit. London: RCP, 2015. www.rcplondon.ac.uk/guidelines-policy/acute-care-toolkit-4-delivering-12-hour-7-day-consultant-presence-acute-medical-unit
  3. ↵
    1. Royal College of Physicians
    . Future hospital: caring for medical patients. A report from the Future Hospital Commission. London: RCP, 2013. www.rcplondon.ac.uk/projects/outputs/future-hospital-commission
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Improving patient flow: setting up of an ambulatory care unit in Nevill Hall Hospital using the CORE role of the chief registrar
S Akhtar, M Brouns, D Wales, C Ward
Clinical Medicine Jun 2017, 17 (Suppl 3) s18-s19; DOI: 10.7861/clinmedicine.17-3-s18

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Improving patient flow: setting up of an ambulatory care unit in Nevill Hall Hospital using the CORE role of the chief registrar
S Akhtar, M Brouns, D Wales, C Ward
Clinical Medicine Jun 2017, 17 (Suppl 3) s18-s19; DOI: 10.7861/clinmedicine.17-3-s18
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Aim
    • Methods
    • Results
    • Conclusion
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Fracture Liaison Services in England and Wales, inequity of access and quality of care after a fragility fracture
  • The end of weak handover
  • Developing service delivery guidelines on acute medical emergencies: challenges and solutions
Show more Health Services and Policy

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians