Aims
To redesign the current A&E and medical services to provide a fit-for-purpose, sustainable model of care for the population served by a district general hospital.
Methods
A project group has overseen the review and re-design of the A&E and medical services provided by a small district general hospital. The six workstreams include:
Minor illnesses
Minor injuries
Frailty services
Mental health services
Acute medical admissions
Alcohol and substance misuse services
Each group has been clinically led, and has involved a multidisciplinary team. The steering group has engaged with local stakeholders including the Community Health Council, local council and patient pressure group and has transformed a position of opposition and apathy to one of genuine engagement and excitement for change. Regular events have been held with primary care colleagues as well as royal colleges on a regional level to discuss and update our model of care.
Results
Final care pathways modelling has been completed and implementation has begun. Our estates department is finalising refurbishment plans, which will allow our model of care to be fully operational by March 2014. In the interim period, pilot programmes in each of the workstreams will be introduced and an intense data modelling and recruitment programme has started, to ensure adequate recruitment and service provision for the target population.
Conclusions
We believe our model, which integrates a front-door GP-led and emergency nurse practitioner support minor injury and illness unit with a stand-alone unselected medical admissions unit, is sustainable and desirable for patients and provides a template for other future hospitals. Integrating not only frailty services, but also mental health and alcohol misuse services is crucial in addressing the needs of a small but important group of patients. With critical care support, our model of care is desirable for both patient outcomes as well as high-quality training
Conflict of interest statement
None declared.
- © Royal College of Physicians 2015. All rights reserved.
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