Table 1.

Examples of innovative practice

Care outside the hospitalIntegrating fall prevention practitioners with ambulance services may prevent or accelerate hospital-based assessment8
Telemedicine may optimise the pre-hospital stroke pathway reducing time to assessment by a senior decision maker, enabling appropriate triage to the local ED, hyper-acute stroke unit or thrombectomy centre, reducing delays to treatment and avoiding unnecessary conveyance9
Integrated electronic recordsAn integrated care record, the Wirral Care Record, in the North-West of England allows all practitioners can see the health and care information across sectors
Well-functioning AMU with SDECSherwood Forest Hospitals NHS Trust acute medical team includes 13 WTE acute medicine consultants, managing an average 50 patient acute take into 83 assessment/short stay ward beds. This, combined with an active SDEC unit, and rapid speciality input when required, enables a very high proportion of patients to be managed without having to be transferred to downstream beds, promoting better patient flow
SDEC pathwaysThe Royal Liverpool Hospital has developed 60 acute medical ambulatory pathways related to specific conditions based on national guidance and written with local specialists provide hospital specialists, providing hospital-specific guidance on rapid assessment and follow up
Speciality ‘hot clinics’North Bristol's ‘Respiratory hot clinic’ enables 72% of patients attending the service to avoid admission10
Multispeciality acute careIn Sandwell and West Birmingham, a ‘consultant of the week’ model in medical specialities enables timed input to the AMU MDT with subsequent reviews11
Speciality pathwaysIn Croydon a speciality-nurse-led service enables 70% of acute referrals to be seen on the same day, with a 28% reduction in length of stay12
  • AMU = acute medical unit; ED = emergency department; MDT = multidisciplinary team; SDEC = same-day emergency care; WTE = whole-time equivalent.