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Online improvement tool rolled out to help ease pressure on emergency departments

An online improvement tool from Getting It Right First Time (GIRFT) and Integrated Urgent and Emergency Care (iUEC) colleagues is being rolled out to help systems ease local pressures on their hospital emergency departments.

The Alternatives to ED (A-tED) tool offers a simple and easily understandable scoring system to measure, rate and compare the accessibility, availability and opening hours of any services patients might use in their area as an alternative to attending the ED, such as walk-in centres, telephone advice services, urgent ‘hot’ clinics and community services.

Together with a sister tool – Alternatives to Admission (A-tA) – they support Integrated Care Systems (ICSs) to enhance capacity in their EDs and admissions wards, improving staff and patient satisfaction by reducing the pressures caused by overcrowding.

More than 20 providers have participated in A-tED/A-tA to date, with positive feedback, and the tools are now being rolled out nationally. Trusts and systems interested in using them can contact england.a-ted@nhs.net for more information.

“We know that too many people show up in ED because they can’t find anywhere else to go. These tools allow healthcare providers to examine the reality of their provision of alternatives to ED attendance and hospital admission, and to identify where there are opportunities to improve access for patients. GP referrals, services like NHS-111, and many NHS pathways, all depend on good availability and accessibility of local alternatives to ED, so the benefits of taking a close and realistic look at local services are invaluable for meeting a population’s urgent care needs.”

A-tED works by scoring each of the UEC services in a local area according to their actual opening hours when compared to the nationally recommended hours of availability. Each service is tested with a short patient scenario. For example, an area’s Same Day Emergency Care (SDEC) service would be scored on how its opening hours and access compare to the recommended 12 hours, seven days a week for stable adult medical patients with suitable conditions. This scoring work is completed online, for both the locally commissioned alternatives and those in the Directory of Services (DoS).

Key stakeholders are then brought together with UEC colleagues – usually virtually – to discuss solutions and collaborate on improvements. This meeting includes hospital clinicians, operations managers, community care leaders, ambulance managers, GP representatives, ICS leads, mental health service managers and social care colleagues, and participants are encouraged to be open and honest with their views in order to get the best outcome.

As well as access to resources and online tools for diagnostics assessment, practical support is offered by ICS relationship leads​ and interactive learning sessions are available to check, challenge and confirm the next steps.

Hereford and Worcestershire Integrated Care System is among the early adopters of the A-tED/A-tA tools.

“We are working through the A-tED process, and it has already been an eye opener for potential improvements in our system. “Improving access to alternatives to ED and reducing admissions is a task that appears daunting and impossible at times. A-tED gives our system a place to start and areas to focus on that we might not have thought of. “It is an excellent piece of collaborative working to undertake in our newly formed ICS.”

As the A-tED/A-tA approach is rolled out further, GIRFT will use the results to feed into a national collection of scores to be reported via the GIRFT SEDIT data set. In time, this will enable analysis of variation, the sharing of exemplars and best practice and better provision of readily accessible alternatives to ED attendance throughout England.

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