Ambulatory Emergency Care – a 4 day pilot (Barts)

AEC 4Ps

The ED at the Royal London Hospital is one of the busiest in London and like many others is congested with exit block and as a result fails to achieve the 4 hour standard.

As part of the Trusts improvement work, I undertook a project to establish ambulatory emergency care (AEC). The purpose of AEC is to provide same day emergency treatment to patients on an outpatient basis rather than as an inpatient. The ambulatory care directory provides a comprehensive list of diagnostic codes which may be successfully managed in AEC.

Analysis of local data identified that there was some AEC activity already ongoing in the organisation although not widely recognised as such. For example there was an established AEC pathway for DVT’s as well as out patient antibiotic therapy, however it was clear there were more patients who had the potential to be managed via AEC and prevent an admission.

I identified local champions who had either an interest or previous experience in working in AEC to define a local aim for a service to be piloted on this site.

Releasing them from their normal duties enabled a pilot to run for 4 days to test the potential for AEC. Staffed by an Acute Physician consultant, 2 senior Nurses and Healthcare support worker and a junior doctor, AEC opened from 10am until 6pm.

The team monitored ED attendances as well as referrals from local GPs to identify suitable patients who did not have any of the established exclusion criteria.

Patients who were suitable for AEC were actively pulled into the area which was located next door to the Emergency Department. There was some uncertainty as to which patients were suitable for AEC so we tried a different approach and simply said, “ We want to know about any patients who might be referred to the medical on-call team for admission, who are stable.”

In the 4 days pilot the team saw 24 new patients and 10 follow up patients.

They presented with a wide variety of conditions and across all age groups 18-93 years.

In addition to numerical information, we also collected patient experience feedback at each stage of their AEC journey.

Admission was prevented in 83% of AEC patients with high patient satisfaction scores being recorded at every stage of their journey.

We are now planning the launch of an extended pilot of ambulatory care running 5 days a week.

During this time we will collect detailed patient level information in order to assist with tariff conversations as well as to measure the impact in terms of ED performance, length of stay and patient satisfaction.

For further information contact  [email protected]
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