Article Figures & Data
Figures
- Fig 1.
Models of ambulatory care – the 4 Ps.
- Fig 2.
Example of an ambulatory emergency care (AEC) model. AEC = ambulatory emergency care
Tables
Gastroenterology > Upper gastrointestinal bleed with Rockall score of 0 > Lower GI bleed with no haemodynamic compromise > Painless obstructive jaundice > Non-acute abdominal pain > Gastroenteritis > PEG related complications Endocrinology > Hyperglycemia without ketosis > Hypoglycemia with full recovery > Type 1 diabetes without ketosis > Electrolyte imbalances > Thyroid disease Infectious diseases > Cellulitis > Osteomyelitis > Urinary tract infections Respiratory disease > Pulmonary embolism > Pneumothorax > Pleural effusions > Asthma > COPD > Community acquired pneumonia > Lower respiratory tract infections without COPD Neurology > Transient ischaemic attack > First seizure > Seizure in known epileptic > Acute headache Oncology 19 > Eg low risk febrile neutropaenia as determined by the MASCC score 20 Miscellaneous conditions > Falls including syncope or collapse > Self-harm and accidental overdose > Anaemia COPD = chronic obstructive pulmonary disease; GI = gastrointestinal; MASCC = Multinational Association for Supportive Care in Cancer; PEG = percutaneous endoscopic gastrostomy Advice Access to outpatients Ambulatory emergency care Assessment unit Acute frailty unit Admission to specialist bed > Patient acceptability > More specialist care for patients > Structure and predictability to the emergency process > Training opportunity > Clinical and cost effective > Alleviates bed pressures > Reduces A&E attendances > Compliance with A&E national 4 hour target A&E = accident and emergency > Chronic obstructive disease outreach > Pleural diseases clinics > Rapid access chest pain clinics > Transient ischaemic attack/stroke clinics > Epilepsy clinic > Pain management service > Functional assessment and support teams > Diabetes nurse specialist > Falls clinic > Macmillan nurses > Outpatient parenteral antibiotics team > Home parenteral antibiotics team > Endoscopy services > Heart failure team > Mental health liaison team Condition Risk stratification tool Pulmonary embolism Pulmonary embolism severity index (PESI), simplified PESI, Hestia criteria Transient ischemic attack and/or cerebrovascular accident ABCD2 and Rosier Scores Asthma Asthma severity (BTS guidelines 2016) Chronic obstructive pulmonary disease BODE index and DECAF21 score Syncope San Francisco Syncope Rule Chest pain TIMI Score and GRACE Score Pneumonia CURB score Acute upper gastrointestinal bleed Glasgow-Blatchford Bleeding Score, Rockall Score - Table 2.
Sample table for calculating the required physical ambulatory emergency care (AEC) capacitya
Arrival time No. of patients Junior doctor time (based on 1 h per assessment) Consultant review time (based on 15-min review) Consultant follow-up time (based on 7.5 min) Trolley spaces (approx. 40% of patients using trolley) Chair or consultant room (approx. 60% of cases use chairs) 08.00–12.00 6 6 1.5 0.75 2–3 3–4 12.00–16.00 10 10 2.5 1.25 4 6 16.00–20.00 4 4 1 0.5 2 2 ↵aThe table is based on 14 new AEC patients per day, and indicates a requirement of four trolley spaces and six chairs to maintain flow during peak demand.
