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Pathology, Paramedics and ED collaboration reducing reducing A/E waiting times
Reducing LOS in ED by using digital technology and advanced data systems.
Emergency departments (ED) are challenged by increasing patient visits, overcrowding and prolonged length of stay (LOS). The cause of these problems is multifactorial.
Delays in the laboratory are often perceived as contributing to delays in care and increased LOS. Implementation of selected point-of-care tests in the ED has been shown to improve ED operations and reduce ED-LOS.
To accomplish these outcomes it is important to choose laboratory tests that directly impact a clinical decision or decrease wait times in patient queues existing within the flow of the clinical evaluation.
Appropriate test selection can therefore achieve significant improvements in the efficiency of ED clinical operations ane how about we ensure the test is apporporately selected prior to ED attendance and sample collected/ tested prior to medical review of the patients based on symptoms/ referral.
Our 4 hour A/E waiting time is impacted by pathology results, Clinician ward rounds and Bed space.
Pathology results to support discharge/admission is a crucial step within the ED process low.
Rethinking the pathway would help reduce the LOS and effective use of resources for the ambulance crew to select pathology tests based on patient symptoms, collect the sample and on arrival to ED prior to clerking send those samples to the laboratory for analysis.
On review by the doctor at 30 minutes in ED results will be back and enable clinicians to make a faster decision about discharge, admission or more test.
This reconfiguration will free clinicians having to see some patients twice, will spread of diagnostics for acutely ill patients and free up beds for patients that are fit to go home.
Case in point, Chest pain is currently a major factor for visiting ED. Using troponin test via this integrated approach will see most patients whom clinicians are not concerned about heart failure discharged faster and the anxiety they face reduced.
For this to work, Ambulance systems need to have access to pathology requesting capability and collect the blood samples, ED clinicians need to be responsible for reviewing the results and Ambulance samples need to be prioritised in the process pathway.
The LOS for a well patient with chest pain with no heart attack will be at most 1 hour in ED far some the current 4-8 hours.
The idea is not fully formed but is an opportunity to think differently and boost capacity.
This can be an add on to one of the virtual ward ideas if possible
Is your idea a commercial offer , or does it have the potential to be a commercial offer?
No
Which part of the pathway does your idea focus on?
All parts of the pathway
This is a good idea. And I suspect there to be several disease or condition diagnosis and treatment regimes that would benefit from 'upstream' diagnostic testing.
Specifically on Troponin testing for suspected cardiac events; there are near-patient testing kits that can assay for Troponin levels. Providing such kits for Paramedics to undertake an assay during the time of transportation could significantly help diagnostic certainty and subsequent immediate and in-hospital ED care.
An RCT and qualitative evaluation would be highly valuable to assess use and wider adoption.
As suggested above, it would be valuable to identify other urgent & emergency care case-types that could benefit from near-patient testing.
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Another way that this could be impacted. Instead of using the Paramedic staff to take sample why not look at what point of care testing wold add impact? Using this, in some cases would mean that a transport to A&E is not required at all. If they do need transporting and an adequate assessment has been done and there is capacity allowing admission rights for Paramedics would also ease flow.
Just an idea and if possible, move walk in centres next door to A&E. Initial triage on arrival and minor cases go to the walk in centre. In Wakefield, these 2 centres are miles apart and A&E contains quite a lot of people who should be at the walk in centre.
I wonder if process improvement techniques might help with some of these problems.. I think we could do something at scale around this and our Lean massive online content potentially help https://www.england.nhs.uk/sustainableimprovement/lean-online/
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