Emergency Medicine and UEC Programme
The GIRFT national review of emergency medicine reported that there are around 15.5 million emergency department (ED) attendances each year – a 74% increase in admissions via EDs since 2012.
The resulting emergency medicine report published in 2021 offers a unique and comprehensive picture of ED attendance, demand and capacity in English trusts – before, during and after COVID-19.
Its focus is on giving trusts accurate information to identify how best to meet the demand for emergency care from their catchment population, with a particular emphasis on the use of the Summary ED Indicator Table (SEDIT). This GIRFT-developed clinical data tool enables EDs – and their trusts – to understand the relationship between demand, capacity, flow and outcomes to support patient outcomes and safe discharge.
GIRFT’s methodology, data, and clinical insight are integral to NHS England’s Urgent and Emergency Care (UEC) programme.
GIRFT’s SEDIT is a core element for UEC in enabling systems to understand their service delivery and identify opportunities to support recovery, improvement and transformation.
Read more below about the tools being developed collaboratively to support urgent and emergency care.
Dr Christopher Moulton
Clinical Lead for Emergency Medicine
Dr Chris Moulton was a consultant in emergency medicine at the Royal Bolton Hospital in the North of England for more than 25 years.
He was the vice-president of the Royal College of Emergency Medicine for six years (2013-19) and is also the co-author of the standard textbook Lecture Notes: Emergency Medicine (Wiley-Blackwell, Oxford).
Chris is a fellow of the Royal College of Emergency Medicine, a fellow of the Royal College of Anaesthetists and a member of the Royal College of General Practitioners. Previously, he was senior lecturer in emergency medicine at the Victoria University of Manchester and secretary of the European Society for Emergency Medicine.
He is now a visiting professor in emergency medicine at the University of Bolton.
The late Dr Clifford Mann OBE
Clinical Lead for Emergency Medicine
Cliff was NHS England’s National Clinical Director for urgent and emergency care and a consultant in emergency medicine with the Taunton and Somerset NHS Foundation Trust. He was appointed an Officer of the Order (OBE) in the 2018 New Year’s Honours list for services to emergency medicine.
Urgent and Emergency Care Programme
GIRFT’s methodology, data and clinical insight in emergency medicine are integral to the collaborative approach of NHS England’s Urgent and Emergency Care (UEC) programme.
Together with the Emergency Care Improvement Support Team (ECIST), GIRFT is working to bring together the expertise of stakeholders at national, regional and ICB level to support system-led delivery on a range of priorities that contribute to UEC recovery, improvement and transformation.
Systems are empowered to lead their own improvement plan, with access to specialist support from teams across NHS England through the UEC’s data and evidence-driven ‘team of teams’ approach.
The UEC programme focuses on:
- Ensuring patients receive care in the lowest acuity setting for their needs, wherever they receive or wait for care (eg; at home or in a care setting);
- Reducing crowding within the UEC system to reduce harm and improve patient and staff experience;
- Reducing unwarranted variation in clinical outcomes, processes, pathways, and health inequalities;
- Lowering the number of avoidable attendances to the ED by directing patients to more appropriate urgent and community care settings;
- Enabling local adaptation and implementation of the best system-wide UEC services, resulting in better navigation, effective use of alternative pathways, and improved quality of care;
- Redesigning pathways to support pre-hospital care and reduce unnecessary conveyances, attendances and admissions;
- Implementing national recommendations.
The SEDIT is an easy-to-use, online depository of emergency medicine data, including novel metrics, which is updated monthly and available to all NHS colleagues.
The SEDIT was created and developed by Getting It Right First Time (GIRFT) clinicians and analysts to support emergency department (ED) teams in their improvement work.
GIRFT’s SEDIT is a core element for the UEC in enabling systems to understand their service delivery and identify opportunities to support recovery, improvement and transformation.
Alternatives to ED (A-tED)
The Alternatives to ED (A-tED) tool is an easy-to-use scoring system to help systems and trusts measure, rate and compare the accessibility, availability and opening hours of patient-facing services which are on offer as alternatives to attending the ED in their area, including walk-in centres, telephone advice services, urgent clinics and community services.
Alternatives to Admission (A-tA)
Alternatives to Admission (A-tA) supports health and care systems with their admissions capacity, and helps them to develop a better understanding of the reasons for ward pressures by examining their provision of alternative services.
NHS Impact provides access to resources for a shared and aligned improvement approach across NHS organisations and systems to embed improvement methodology.
Go to UEC resources on NHS Impact >
The SAMIT is a suite of 50 key metrics relevant to the acute medical patient pathway, for use by teams in Acute Medical Units (AMUs) and Same Day Emergency Care (SDECs) in England. It offers a deep understanding of an acute medical service, accounting for demand, capacity, processes, behaviours and performance.
The dashboard can be viewed at site or system level and includes an overview of key activity and resources (consultant and nursing numbers, physical bed availability) linked to capacity, helping to highlight gaps which might be impacting on the delivery of a service. It also includes an overall ranked patient flow score – the GIRFT Acute Medicine Index (GAMI).
GIRFT online tool supports emergency departments in managing capacity and patient flow
Matching emergency care capacity to local demand, improving ED patient flow using GIRFT-EM metrics and reducing unwarranted variation (across specialty pathways) are key recommendations made within the Getting It Right First Time (GIRFT) programme’s national review of emergency medicine.
Among the new data-led recommendations, the report also advocates for the provision of co-located primary care services at hospitals with high ED attendance rates.
Addressing poor IT systems and processes that reduce ED productivity by adding to the clerical burden (e.g. high ED agency and locum costs) are other measures put forward for further improvement.
Watch the video about the Emergency Medicine report…
Click above to play the Emergency Medicine national report video