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Exit Block in Emergency Departments - 6 month review
This winter, performance against the 4 hour standard has deteriorated across all four nations of the UK. This means Exit Block has worsened. In September 2014, we launched our Exit Block campaign. Six months on, with the recent winter pressures and increasing A&E attendances, we are reaffirming our commitment to this issue.
This new report brings together the latest research on crowding and Exit Block in EDs, including national statistics on the impact of Exit Block, alongside personal accounts from A&E consultants of the impact of crowding and Exit Block in their departments. The launch of our report comes just after the Secretary of State for Health, Rt. Hon. Jeremy Hunt MP, announced the UK government’s plans to reduce the number of avoidable deaths in the NHS. Tackling exit block must be part of this initiative as it accounts for hundreds of deaths per year.
Royal Title for the Royal College of Emergency Medicine
The College is delighted to announce that it has been granted the title ‘Royal’. The College will now be known as ‘The Royal College of Emergency Medicine’. Please read the press release here for further details.
The attractiveness of a career in Emergency Medicine - report published
The College of Emergency Medicine has published The attractiveness of a career in Emergency Medicine: A survey of UK trainees, following its 2013 survey of UK Emergency Medicine trainees in regards to their future intentions, ambitions and opinions about working as an EM Consultant.
For more information and to download the press release, please click here.
The College of Emergency Medicine today launches its STEP campaign in England. The College has been calling for action to address the significant challenges facing A&Es, and whilst some progress has been made, there is much work to do to provide a safe and efficient service for our patients. To rebuild the Emergency Medicine service the College is calling for four steps to be taken which address safe and sustainable staffing levels, fair and effective tariffs and funding, tackling exit block and overcrowding, and co-locating primary care services with A&E. The College urges Government, politicians and NHS leaders to work together to take the four steps needed to rebuild emergency care. For further information please click here.
Download the press release here.
Investigation into the care of people detained under Section 136 of the Mental Health Act who are brought to Emergency Departments in England and Wales
The College of Emergency Medicine welcomes the RCEM Section 136 investigation report published today.
The care of people suffering a mental health crisis has received welcome political attention recently. Attention on its own, however, is not sufficient to improve care. We investigated the care of people brought to emergency departments who had been detained under Section 136 of the Mental Health Act, as we have received many reports of concerns of care for these vulnerable people.
This report, resulting from our investigation, reflects the deep concern that many Fellows working in Emergency Departments have about the care of people suffering a mental health crisis. We understand that police cells are a poor place for these people, but so also is a busy emergency department, particularly if the patient has no physical health problems. An emergency department can be a frightening and disorientating place for a person suffering a crisis. We call on commissioners and Ministers to take immediate and effective action to improve access to emergency mental health care, so that people can be looked after in the best possible environment.
The College President, Dr Cliff Mann, said: “This report highlights some of the real challenges we face in emergency medicine when helping patients with serious mental health challenges.”
Recruitment - National Medical Advisor for Urgent Care
Please find a link to a role being advertised this week for a National Medical Advisor for Urgent Care:
Study Day for Emergency Physicians: Global Emergency Medicine – what can YOU do?
The College of Emergency Medicine is running a study day for emergency physicians at its London headquarters on 31 October 2014.
Emergency Physicians can book on this programme for just £75 (plus a £5 optional donation to International Global Health) through the College website here.
Seasonal flu vaccination, 2014/15
Letter from the CMO Flu jab_Oct14
The College of Emergency Medicine today launches its strategy to improve the working lives of clinicians working in Emergency Departments in the UK. The guidance documents are specifically aimed to help guide Clinical Directors of Emergency Medicine, clinicians, employers and commissioners of emergency healthcare.
Download the press release
See the full guidance
People are voting with their feet for the kind of care they want and are choosing the Emergency Department over the GP. In England alone there are 21,000,000 A&E attendances a year and rising. This in NOT just a national trend but worldwide. EDs are becoming the modern method of dispensing healthcare; you can go anytime of the day or night, see a highly trained doctor and get the most sophisticated diagnostics, get a pill and be out in 5 to 6 hours, so why not?
On 22 September, HKS Architects invite you to think about things as they are and as they might be in A&E. Jim Lennon, the US Advisory Board “Go To Guy” for Emergency Centre design, will talk about:
- New Layouts that increase patient flow, are more efficient to operate and cost less to build.
- New findings on the advantages and disadvantages of the spilt flow ED.
Date: 22 September 2014
Time: 13:00 - 14:00
Join this online discussion by registering here.
Non-technical skills (NTS) have a vital role to play in Emergency Medicine practice. There is increasing awareness that a clinician must not only possess good technical skills but should also be proficient in a variety of interpersonal and cognitive skills in order to optimise patient care. Non-technical skills reduce the opportunity for human error and enhance risk management both of which are known to improve patient care.
The College has prepared a Non-technical Skills-Top 10 Tips as a guide on how to maximise emergency physicians non-technical skills for the benefit of patients and staff.
Monitor, NHS England and NHS Trust Development Authority are running a series of webinars looking at the issues that impact on patient care flows through urgent and emergency care services.
The webinars will also explore best practice in mitigating pressure on emergency departments and delivering safer, high quality and more responsive emergency care services.
The College of Emergency Medicine welcomes and endorses this important document issued by the Royal College of Physicians entitled 'Future hospital: More than a building.' The statements and rationale complement our recent joint publication 'Acute and emergency care - prescribing the remedy' and we will actively support these five key messages.
The Royal Society for the Prevention of Accidents and the College of Emergency Medicine have formed an
alliance to reduce injuries and relieve the pressure gripping Accident and Emergency departments. There are 21million A&E attendances across England each year, with accidents being a principal cause. Among their work together, the two organisations will take forward a project on data collection, seeking to bring about the introduction of standardised A&E attendance data to highlight the burden of accidents on emergency care.
Download the press release here
The College of Emergency Medicine is calling for urgent action to address blocked A&E departments. A new condition called ‘exit block’ is harming patients: they are put at risk when ‘exit block’ occurs. This happens where you can’t get patients from A&E into a hospital in patient bed. This is explained in more detail in this video:
Over 500,000 patients a year are affected.The College of Emergency Medicine says that this is unacceptable. The College is calling on hospital Chief Executives and their Boards to make sure that this issue is on their agenda. In Somerset, Musgrove Park Hospital, has taken up the challenge of tackling Exit Block. They are working on arange of the solutions we featured in our College guidance. Their approach is shown in this video:
The College of Emergency Medicine advocates that all emergency departments should have a co-located primary care/ urgent care facility to provide the most appropriate care for patients with emergency and urgent care needs. However many such primary care/urgent care facilities exist in locations some way from the nearest emergency department. In accordance with best practice such units should be part of an urgent and emergency care network with the necessary resources to ensure proper provision of services and governance arrangements.
PARAMEDIC-2 – The Adrenaline Trial, is a double-blind placebo-controlled trial which will involve five ambulance service NHS Trusts (London Ambulance Service, North East Ambulance Service, South Central Ambulance Service, Welsh Ambulance Services, and West Midlands Ambulance Service) and will enrol 8000 OHCA patients. Patients enrolled in the trial and who are transported to hospital should be treated, on arrival, according to standard resuscitation procedures, including the use of adrenaline if indicated.
The College of Emergency Medicine have met with the National Association of Primary Care (NAPC) to discuss the ongoing challenges facing urgent and emergency care services and what steps can be taken to relieve the current pressures on Emergency Departments. The College and NAPC agree that GP's are an important component in the urgent and emergency care system and will be working together to build strategic and practical approaches to find solutions to the ongoing challenges facing these services.
Today (3rd Sept) the College of Emergency Medicine has published the results of a national audit of the management of severe sepsis and septic shock in UK Emergency Departments. This follows the launch yesterday of five clinical toolkits which map the path to success in sepsis management, produced by the UK Sepsis Trust and others. An Emergency Medicine specific toolkit, together with the full audit report, can be found here:
The UK Sepsis Trust has led the development of a series of clinical toolkits which map the path to success in sepsis management. Developed with the Royal Colleges and specialist Societies, these toolkits provide pragmatic solutions to improving sepsis care across the healthcare system. They are supported by robust education and are designed for immediate implementation. Exemplar standards will help identify those units excelling at sepsis care.
The clinical toolkit for Emergency Medicine has been developed jointly by the College of Emergency Medicine and the UK Sepsis Trust. It is designed to provide operational solutions to the complexities challenging the reliable identification and management of sepsis, and complements clinical toolkits designed for other clinical areas. We acknowledge use of some content from the Acute Medicine Toolkit developed by the UK Sepsis Trust & Royal College of Physicians.
Health Profiles have been developed by Public Health England (PHE) to improve availability and accessibility of health and health-related information. The Profiles provide a snapshot overview of health for each local authority in England. They are intended to help local government and health services make plans to improve local people's health and reduce health inequalities. http://fingertips.phe.org.uk/profile/health-profiles
We welcome this briefing and look forward to working alongside the NHS Confederation to help deliver these objectives. As highlighted in the College’s recent report ‘Acute and emergency care - prescribing the remedy’ A&E departments already provide a 7 day a week service and their patients would be greatly assisted if this approach was more widely adopted throughout the hospital system. The need to locate GP services with the A&E service is something that this College fully endorses, as there is a real need to provide effective alternatives to A&E for patients without acute severe illness or injury. Download this statement here. Full report is available on the
A&E Information Sharing Audit - 2014
The sharing of de-identified violence data between A&Es and local partners is a key Coalition Government commitment. This mandatory return is being conducted of Type 1 A&Es to determine the extent and quality of information sharing that is taking place in England. All Type I A&Es are asked to ensure that they respond.
The online questionnaire can be found here: https://www.surveymonkey.com/s/AEaudit14
Responses should be submitted no later than Friday 29th August.
Further information about the data collection can be obtained by contacting:
Sofya Gorelova: 0207 2105526
Bayan Amin: 0207 2105442
Or email: InfoSharingAudit2014@dh.gsi.gov.uk
New best practice guidance - Frequent Attenders
The College has published two new best practice guidelines:
Frequent attenders in Emergency Departments- This guideline has been developed to provide advice to Emergency Departments in the United Kingdom, regarding the management of ‘frequent attenders’ to the Emergency Department.
Care of frequent attenders at multiple Emergency Departments- The guideline offers recommendations for the identification and management of adult frequent attenders at multiple Emergency Departments (FAMED).
Public Health England have issued a CAS alert regarding the ebola outbreak in West Africa. Although the likelihood of imported cases is low, health care providers in the UK are reminded to remain vigilant for those who have visited areas affected by viral haemorrhagic fever and who develop unexplained illness. Read the full alert:
The College of Emergency Medicine is engaging with the Government, NHS, healthcare bodies and Police services about improving care arrangements for patients detained under section 136 of the Mental Health Act.
The College is conducting this survey to obtain a greater understanding about how the use of section 136 and local arrangements for places of safety varies across England and Wales. We would be grateful if the clinical lead or a designated individual from each ED could submit a response.
The results of this survey will be shared with Government and outside agencies, though individual comments will remain anonymous. Many thanks in advance for your assistance in answering this survey. The survey will close on Friday 29th August 2014. https://www.surveymonkey.com/s/section136
New NICE quality standards - Delirium and Feverish illness in children
NICE have published two new quality standards:
Please take a few minutes to complete this short survey which will be informing a major research project on epistaxis. The purpose of the survey is to establish the range of national practice in the management of patients with epistaxis by UK emergency physicians. This information will be used to help inform the design of a planned study to establish the effectiveness of topical intranasal tranexamic acid in the management of acute, apontaneous epistaxis. It is aimed to establish how individual practice varies by both clinician and by centre and to assess the utility of local guidelines and standard operating procedures. https://www.surveymonkey.com/s/BGDBJBG
Acute and emergency care: prescribing the remedy is published today jointly by the College of Emergency Medicine, Royal College of Paediatrics and Child Health, the Royal College of Physicians and the Royal College of Surgeons. This report sets out 13 recommendations to address the challenges facing urgent and emergency care services across the UK and Ireland. Given the continuing challenges experienced by patients and those working in acute and emergency care services the College of Emergency Medicine convened an emergency summit. On 4th March 2014 key policy makers, opinion formers and leaders in acute healthcare were brought together to develop solutions to the challenges. This report contains the consensus recommendations of this summit. The consensus nature of the proposals reflecting the needs of patients whether ill or injured, the elderly and children is unique. The report can be accessed here.
This Thursday and Friday July 10-11, 2014, heads of state, health ministers, and other national representatives will convene at the United Nations General Assembly headquarters in New York City to re-affirm their support for a 2011 political declaration to reduce the burden of heart disease, stroke, diabetes, cancer, and respiratory
diseases caused chiefly by poor diet, tobacco, excess alcohol, and physical inactivity.The 2011 United Nations High Level Meeting and Political Declaration was only the second to focus on a health issue since World War II.
In barely a week, more than 160 non-profit public interest groups and experts from every populated continent signed a joint-statement calling for public health legal safeguards in the context of commercial trade agreements and protections against conflicts of interest, especially industries with vested interests in the causes of cures of NCDs. The College of Emergency Medicine is among the signatories. The joint-statement and current list of signatories is
available at: http://cspinet.org/canada/pdf/conflict-of-interest-safeguards_health-trump-trade.july2014.pdf
If you have an interest in driving quality improvement in health, public health or social care, experience of working on committees and working groups, and highly developed interpersonal, communication and team working skills, then NICE would like to hear from you.
You will not be representing your organisation but will bring your expertise, experience and knowledge of current practice. The time commitment is one day a month, for a three year period, and your expenses will be reimbursed (if you are a general practitioner, locum cover will be covered).
More information on how to apply can be found at www.nice.org.uk/Get-Involved/Join-a-committee/Member-Quality-Standards-Advisory-Committee and information on NICE quality standards at www.nice.org.uk/standards-and-indicators.
You can also contact Jenny Mills at NICE on email@example.com or by calling 0161 870 3269. The closing date for applications is 5 August 2014.
This report is the result of a 12 month inquiry which has focussed in particular on Chronic Obstructive Pulmonary Disease (COPD) and asthma. A large number of MPs and policy makers were inspired to take action, when hearing that the UK has the worst death rate for respiratory disease amongst OECD countries. The report points to a combination of factors contributing to respiratory deaths: a lack of awareness, poor standards of care and under-investment in clinical leadership, data and medical research. The report makes a number of recommendations on what needs to happen to enable respiratory conditions to stand on a par with the other ‘big killer’ diseases. View the report on the Asthma UK website: http://www.asthma.org.uk/campaign-appg
Healthcare Education East Midlands have produced this helpful video about training in Emergency Medicine https://www.youtube.com/watch?v=K8HJ7gg1jjg&sns=tw
A new approach to caring for dying people based on the needs and wishes of the person and those close to them has been launched and welcomed by Care and Support Minister Norman Lamb.
It takes the form of five new Priorities for Care which succeed the Liverpool Care Pathway (LCP) as the new basis for caring for someone at the end of their life. The new approach focusses on giving compassionate care and is a move away from previous processes and protocols. It recognises that in many cases, enabling the individual to plan for death should start well before a person reaches the end of their life and should be an integral part of personalised and proactive care.
The Health Service Ombudsman has published a report which details the tragic case of how a family were let down by four NHS organisations because of repeated mistakes, which led to the avoidable death of their three year old child from severe sepsis poisoning. This case reinforces the need for independent investigations when serious incidents occur, which look at the root cause of the complaint and the role of human factors. All service providers should adopt this approach to help them understand why mistakes happen and to help improve services for everyone.
Central and North West London NHS Foundation Trust have produced an excellent video explaining what liaison psychiatry does and how it benefits patients. Watch the video here: http://vimeo.com/98629035
A number of events are being organised across the country about how local services can develop and improve services for those with urgent mental health needs. For more details go to: http://www.crisiscareconcordat.org.uk/events/
The College is a participant in a major national study - the High-intensity Specialist Led Acute Care (HiSLAC project) (www.hislac.org) to evaluate the benefits of senior clinical decision making in the management of patients. The aim of the study is to demonstrate both the effect size and resource implications associated with such provision. The research team have obtained a national grant to undertake this work, part of which is a brief web based survey of key staff.
An England-wide point prevalence survey of specialist involvement in emergency admissions. All consultants and associate specialists from all specialities in 122 acute Trusts across England will be invited to complete a very short web-based survey to determine the number of specialists physically present and providing care for acute admissions on Sunday June 15th and the following Wednesday 18th.
The survey has a minimum of 3 and maximum of 9 questions, and takes less than two minutes to complete. To complete the survey, go to: http://www.hislac.org/m4yisjaf2cdvis6y4frlcngy1gmv6ydh.html
Monitor’s research has found no clear evidence that smaller acute hospitals performed any worse clinically than larger counterparts. View the report at: https://www.gov.uk/government/consultations/challenges-facing-small-acute-nhs-hospitals
The College has published a revised version of this guideline to assist managers and clinicians who are trying to reduce crowding in their hospital Emergency Departments. The guideline explains the causes and consequences of crowding. This guideline offers suggestions to reduce the effects of crowding and improve the safety of an Emergency Department.
Today's meeting (9 June 2014), organised by the College of Emergency Medicine, will bring together Northern Ireland's most senior representatives of emergency medicine, general practice, nursing, social work and managers to improve the quality of unscheduled and emergency care in Northern Ireland.
The College is a participant in a major national study - the 'High-intensity Specialist Led Acute Care (HiSLAC project) (www.hislac.org)' to evaluate the benefits of senior clinical decision making in the management of patients. The aim of the study is to demonstrate both the effect size and resource implications associated with such provision. The research team have obtained a national grant to undertake this work, part of which is a brief web based survey of key staff.
On June 9th the project will launch an England-wide point prevalence survey of specialist involvement in emergency admissions. All consultants and associate specialists from all specialities in 122 acute Trusts across England will be invited to complete a very short web-based survey to determine the number of specialists physically present and providing care for acute admissions on Sunday June 15th and the following Wednesday 18th.
The survey has a minimum of 3 and maximum of 9 questions, and takes less than two minutes to complete. Please look out for the email from your Trust project lead and Medical Director on June 19th. The college of Emergency medicine strongly supports this important piece of work and we would like to thank you in advance for your participation.
This guideline from the College provides more detailed guidance for the ED regarding the management of patients who are suspected of having concealed illicit drugs. It covers our legal responsibilities, interactions with the police and provides clinical guidance. The guidance is endorsed by the Faculty of Forensic and Legal Medicine.
The College of Emergency Medicine today issues a call for action to address the challenges facing Emergency Departments in Scotland. The publication today of '10 priorities for resolving the crisis in Emergency Departments' clearly sets out what needs to be done.
Download the document here
Mental Health problems are a frequent reason for patients to attend an emergency department. Often such attendances are avoidable and this campaign by the Mental Health Foundation seeks to raise awareness of both the problems and solutions.
Emergency Departments are seldom the best place to discuss and resolve psychiatric issues but distressed patients often have nowhere else to go. The College sets great store in supporting the education of all staff working in A&E to identify mental health problems and to provide and co-ordinate timely care and support for such patients.
Find out more about the campaign and ways you can get involved here: Mental Health Awareness Week 2014
The College has provided a worked example of how to set about calculating the number of hours of non-clinical (SPA) time that Consultants working in Emergency Departments require.
The College remains convinced that to deliver a safe, effective and efficient service each consultant will need at least 10 hours per week engaged in the activities this document describes. The list of activities described is not exhaustive and each department will have some specific local requirements. Similarly some of the activities listed here will not be relevant.
Download this document here
The report of the National Review of Asthma Deaths was published on 6 May 2014 to coincide with World Asthma Day. The College of Emergency Medicine has endorsed the findings. There are specific recommendations for Emergency Departments.
The Home Office and Department of Health jointly launched a survey to get practitioners and stakeholders’ views on the operation of police powers under the Mental Health Act 1983 (Sections 135 and 136). The survey is available here https://www.gov.uk/government/consultations/review-of-the-operation-of-sections-135-and-136-of-the-mental-health-act and will be open until Tuesday 3rd June.
As you may be aware, 2014 marks the 40th anniversary since Graham Teasdale and Bryan Jennett published the Glasgow Coma Scale. Sir Graham is currently leading a study to understand the variation in how the GCS is currently used to ascertain whether it might be improved. Your input into this would be greatly appreciated. Please could you fill in the survey via the link below. It takes only about 3 minutes and the data is collected anonymously. https://www.surveymonkey.com/s/GWXKJRL
Public Health England and NHS England have published a plan that sets out a coordinated and evidence-based approach to planning for and responding to the demands of flu across England.
The College has endorsed this guidance published by the Faculty of Forensic and Legal Medicine.
This RCPCH document provides a competency framework for all groups (ranging from non-clinical staff to experts), information on education and training and role descriptions for named and designated professionals. This document will help all health staff understand their responsibilities in recognising child maltreatment and how to take effective action. http://www.rcpch.ac.uk/child-health/standards-care/child-protection/publications/child-protection-publications
Revised guidance published - The College has revised and reissued our best practice guideline on Bier's Blocks.
Health Education England (HEE), along with the College of Emergency Medicine (EM) UK, is offering places for doctors from India to develop your emergency medicine skills and gain valuable clinical experience. The programme is up to four years, after which you will return home to use your skills to care for patients and share learning with colleagues.
Eligible candidates are invited to apply and, if successful in the interviews, will be offered a rotational post in hospitals in one region of England. The programme will last up to four years and will include the opportunity to attend a College of Emergency Medicine organised programme to prepare you for either the Membership of the College of Emergency Medicine (MCEM) or the Fellowship of the College of Emergency Medicine (FCEM) examinations, depending on your existing experience. You will also be given access to the College’s e-portfolio so you can officially document your progression and reflect on the skills you’ve acquired, as well as access the College’s e-learning resources.
The College is concerned about the new targets being considered by the Welsh Government especially their plans to change the targets affecting A&Es. Press release: Wales health targets
BEST is a workforce planning tool for use at local level in your Emergency Department (ED) to allow any disparity between nursing workload and staffing to be highlighted. The tool allows you to:
- analyse the volume and pattern of nursing workload in your ED
- track this against your rostered staffing level
- calculate the whole time equivalent workforce and skill mix which would be required to provide the nursing care needed in the department during the audit period.
The tool has been developed by the RCN Emergency Care Association (ECA) and Faculty of Emergency Nursing (FEN).
- The award is designed to celebrate and reward trailblazing nurses who have gone out of their way to work effectively, efficiently and empathetically with their patients and have introduced new techniques to solve problems and help improve lives.
This year, there are three categories:
Pioneering Emergency Nurse
Pioneering Practice Nurse
Inspirational Student Nurse
The winner of each category will be awarded a £500 bursary and a hand crafted, unique Pioneers of Care broach, which will be presented at the Welcome Foundation, Central London on the 4th July 2014. http://www.welchallyn.com/regions/europe/uk/Promotions/pioneers-of-care/default.htm
Deadline March 21, 2014
The Emergency Medicine Foundation (EMF) is seeking proposals for a $10,000 international emergency medicine research grant. The proposal deadline has been extended to March 21, 2014 at 5:00 pm CST. You can find the RFP and submission instructions on the EMF website at http://www.emfoundation.org/EMFGrants/. Early submissions are appreciated.
7 - 9 July 2014, Cambridge - RCEM has brought together an international faculty to deliver a short course that offers clinicians and design professionals an opportunity to understand the requirements and evidence that supports the design of the smartest Emergency Department. Read more here. To apply go to www.cam-pgmc.ac.uk
On 18 February 2014 the Government published a joint statement about how public services should work together to respond to people who are in mental health crisis. The College of Emergency Medicine is a signatory to the concordat and welcomes and supports this commitment to work together to improve the system of care and support so people in a crisis because of a mental health condition are kept safe and helped to find the support they need, whatever the circumstances in which they need help and form whichever service they turn to first.
NHS Protect have published a series of videos that have been developed to complement the meeting needs and reducing distress guidance and assist in challenging behaviour awareness training, staff inductions or as a standalone learning resource for staff involved in direct patient care. Suitable for both clinical and non-clinical staff working in a range of settings. http://www.nhsprotect.nhs.uk/reducingdistress/training-videos/
In January 2014 the new National Patient Safety Alerting System (NPSAS) was launched to strengthen the rapid dissemination of urgent patient safety alerts to healthcare providers via the Central Alerting System (CAS). This three-stage alerting system also provides useful educational and implementation resources to support providers to put appropriate measures in place to prevent harm and encourage and share best practice in patient safety. The system builds on the strengths of the previous National Patient Safety Agency (NPSA) patient safety alerts and rapid response reports and is based on systems used in other high risk industries. For more information about the new system go to: http://www.england.nhs.uk/ourwork/patientsafety/psa/national-psa-system/
Monitor and NHS England have published the 2014/15 National Tariff Payment System. This document sets out national prices for services; the operation of national business rules, such as the marginal rate, which affect national prices, and; the efficiency factor and deflators which apply to services under national and local tariffs. Download this document here.
The College welcomes the confirmation today of changes to the acute admissions tariff rules. Meetings with the Secretary of State in December recognised the need for such changes. The College would expect the Commons Health Select Committee to explore the issue of tariff reform with Sir Bruce Keogh and Professor Keith Willetts during their testimony this afternoon, as financial realities will be a key driver in delivering their reforms. Download this statement here.
The Point of Care Foundation is an independent charity working to improve patients’ experience of care and increase support for the staff who work with them. The foundation has published a report emphasising that caring about the people who work in healthcare is the key to developing a caring and compassionate health service.
The College has prepared a document to support doctors in developing their clinical skills. This document includes checklists for various generic skills (history taking, examination, leadership of a resuscitation station) that shows the steps in these skills. It is hoped that candidates will find this useful in their preparation for workplace based assessments and OSCEs.
The countdown has begun to NHS Change Day 2014. The first NHS Change Day on March 13th 2013 was unprecedented. It was a 'game changer' that provided the amazing grassroots momentum so many staff, patients and people working with the NHS needed.
A single tweet grew into a movement that managed to successfully harness the passion, drive, commitment and innovation that we see every single day from staff. Last year saw 189,000 pledges to make things better. This year our goal is for 500,000.
Anyone can make a pledge. We ask everyone to embrace the energy of Change Day and to PLEDGE, SHARE, DO and INSPIRE. To make the NHS the best is can be. Let's do something better and courageous together. It's time for NHS Change Day 2014 to begin.
In 2014, an Emergency Medicine Run Through Training pilot will commence. Whilst there are various components within the pilot, this guidance has been specifically created to clarify arrangements for offering run through training to existing, eligible Acute Care Common Stem (ACCS) Emergency Medicine (EM) and CT3 EM trainees.
Every acute hospital needs a liaison psychiatry service to manage the mental health needs of patients being treated primarily for physical health conditions, according to a new report published on 20th December 2013 by the Royal College of Psychiatrists. Implementing liaison services could improve quality of care for patients, reduce rates of readmission, decrease length of stay, and save trusts millions of pounds.
The report, Liaison psychiatry for every acute hospital, has the backing of six other professional bodies: the College of Emergency Medicine, College of Mental Health Pharmacy, Royal College of General Practitioners, Royal College of Nursing, Royal College of Physicians and the Society for Acute Medicine.
The report makes a series of recommendations on how liaison services should be designed, including:
- Liaison psychiatry services should be funded and planned in conjunction with physical services, so that both the physical and mental health problems of patients can be well managed.
- Patients in acute hospitals should have equitable access to a consultant psychiatrist for mental health problems, as well as to a consultant for their physical health.
- All liaison psychiatry service functions should be provided five days a week, and all emergency or urgent clinical problems should be covered seven days a week.
- Liaison services should aim for a maximum response time of within 1 hour for emergency referrals and 1 day (usually within 5 working hours) for urgent referrals.
The College of Emergency Medicine today issues a call to readdress the previous term 'crisis' into five key challenges facing Emergency Medicine. Considerable progress has been made in discussions with HEE, Monitor and the DH. Negotiations with employers are ongoing via the BMA, and the Keogh review has identified the need for improved access to alternatives to A&E departments. These developments are evidence that we have made progress; but the 5 key challenges we identified in our document 'Priorities for Resolving the Emergency Crisis' remain and their resolution will take significant concerted action over the coming months.Download this press release here.
The College of Emergency Medicine welcomes the publication of the report by Health Education England entitled 'Emergency Medicine - Background to HEE proposals to address workforce shortages'.
The report’s proposals and recommendations are for improvements in the future workforce of emergency departments to ensure that patients receive consistent, high quality, safe and effective care.
8/12/2013 - The College of Emergency Medicine endorses the concerns of the Patients Association and the findings of the National Audit Office. Access to primary care is a key determinant of attendances to emergency departments. Where access is good, attendance rates are substantially lower. Patients value the ability to consult a general practitioner for most of their health concerns. Emergency departments are neither designed nor resourced to deal with primary care issues.
The University of Exeter is researching Emergency Department (ED) consultants' perceptions of their psychological health and wellbeing. All physicians working at consultant level in emergency departments (EDs) across England have been invited to take part in an online questionnaire. If you agree to join the study it will take around 10-15 minutes to complete and your answers will be stored electronically and anonymously.
Please click on this link http://survey.ex.ac.uk/index.php?sid=62142&lang=en to participate. The survey will remain open until enough responses have been gathered. Thank you for your support.
NOTE: PLEASE DO NOT COMPLETE THE ONLINE SURVEY IF YOU HAVE AGREED TO PARTICPATE IN ONE-TO-ONE INTERVIEWS RELATED TO THIS RESEARCH
The Safer Care Committee has developed the safety toolkit which aims to describe the structures, processes and skills required for a ‘safe’ Emergency Department. There are resources identified within each section to stimulate, provoke and challenge, as well as to guide personal development. There are overlapping references and differing perspectives but the vision is of a resource for change and development. Download the toolkit:
Bridging the Gap is a joint report from the Royal College of Psychiatrists and Centre for Mental Health which focuses on immediate improvements that can be made to the care and support offered to millions of NHS patients by enhancing mental health support within or on the interface with physical health services. http://www.rcpsych.ac.uk/policyandparliamentary/projects/live/bridgingthegap.aspx
New NHS guidance on how to prevent and manage challenging behaviour related to clinical conditions is launched today, Thursday 5th December, 2013. It is for the use of clinical and non-clinical NHS staff and managers and may also be of interest to patients and service users, carers and families. http://www.nhsprotect.nhs.uk/reducingdistress/
This guideline updates the previous 2008 version and provides guidance on the stocking of antidotes in Emergency Departments in the UK.
A design solution to reduce levels of violence and aggression in Accident & Emergency (A&E) departments created by PearsonLloyd and commissioned by the Department of Health and Design Council, has found significant improvements in overall patient experience, a reduction in levels of frustration hostility, and cost saving benefits.
Download the latest algorithm from Public Health England
Find out the latest news from the International Federation for Emergency Medicine
The College has published a basic guide to working in Emergency Medicine for the NHS in the UK to help doctors familiarise themselves with the structure and terminology.
The Unified Diagnostic DAtaset (UDDA) integrates ICD10, SNOMED, CDS and ‘real world’ descriptions of disease. The aim is to enable consistent coding in Emergency Departments, in a way that is easy for IT systems providers to implement. Download the latest version and release notes here
This position papers provides guidance on commissioning an integrated emergency care system and provides ten key recommendations which should always be considered when the configuration of locals EDs are made. Download this guide here.
The College of Emergency Medicine welcomes the news this morning that an agreement has been reached on new contractual arrangements for General Practitioners. The GP community is an important part of the answer to the challenges faced by Emergency Departments as we cope with rising patient numbers.
The College of Emergency Medicine welcomes the review announcement made today (13th November 2013). However, this review is very much future focussed and the crisis is here with us now. For further information about this review please see this link: http://bit.ly/18qvXTO
The College has published ’10 priorities for resolving the crisis in Emergency Departments’ which clearly sets out what action needs to be taken to address the current crisis in A&E. The College through its Members is playing its part and we are working in 5 key areas. However, this crisis cannot be solved by us alone, we need urgent action by all stakeholders to work with us to provide a stable long term future for A&E services whilst tackling the short term immediate pressures. This is why we have identified 5 priorities for us and 5 for the Government and NHS leadership to grasp to address this crisis. Our proposals are the collective view of practicing Emergency Physicians; they represent cost-effective solutions to ensure we can deliver safe patient care.
MHRA recall - certain batches of Novomix 30 Insulin: See full details here
Support the 8th National Carbon Monoxide Awareness Week: 18 –24 November 2013 - CO Awareness and the College are keen for all to support the 8th national carbon monoxide awareness week by raising awareness of the dangers from carbon monoxide poisoning, how to avoid it and supporting victims of CO poisoning. A variety of posters and information leaflets for display in your ED are available from http://www.covictim.org/file3 and from the College's guidelines page.
Follow the work of CO Awareness on Twitter https://twitter.com/coaware
The Safer Care Committee has developed a safety checklist. This allows you to assess how well you integrate and consider safety in your departmental activities and makes suggestions for which staff need to be involved.
Registration is now open. The deadline for submission of abstracts is 30th November 2013. Go to www.icem2014.org for more details.
The College of Emergency Medicine welcomes this report from the General Medical Council (GMC) which identifies the important issues relating to the medical workforce in Emergency Departments.
The Patient Safety Award is awarded annually to an individual or hospital team that can demonstrate evidence of improved patient safety as a direct result of an innovation within their emergency department. The inaugural prize was awarded to Imperial College Healthcare NHS Trust for ‘Project to improve accurate identification of emergency patients’ at the 2013 RCEM Scientific Conference at Twickenham. Read more about this here.
Never Events are incidents which are considered unacceptable and eminently preventable. The Safer Care Committee has prepared a guide which higlights Never Events that could occur within your Emergency Department and how to mitigate their risks. Download this guide here.
This report, the first of its kind, describes the working practixes of consultants and other senior decision makers in the Emergency Department, the pressures they face and the impact on their working lives. It shows that overall 62% regard the job they are doing running the Emergency Medicine service as unsustainable in its current form and 94% of respondents tell us that they regularly work in excess of their normal planned hours to help deliver the service. The College calls for change to address this. Download the report and press statement here.
The College has published a series of documents to provide better guidance for doctors, employers and commissioners on ways in which to protect the senior medical workforce in Emergency Medicine (EM) in their present working practices. This is vital not only to retain safe, sustainable working but also to create careers that are attractive to our future trainees and satisfying for our present colleagues. The documents are out for consultation and we want to hear your views on how to develop this work.
Please complete this online survey from the University of Exeter which investigates Emergency Department (ED) consultants' perceptions of their psychological health and wellbeing. http://survey.ex.ac.uk/index.php?sid=62142&lang=en
The guidefor Emergency Medicine brings together key information regarding current revalidation requirements and processes in all four countries of the United Kingdom. It has been developed as a web-resource for Emergency Medicine (EM) doctors who may have queries about their revalidation. The guide advises on the requirements of revalidation which are current at the time of publication.
This document has been developed in response to a perceived need to improve and standardise clinical care in patients with a suspected fracture of the scaphoid bone. The intention is to distil the best available evidence into practical advice for clinicians working in the Emergency Department. The information is presented in the form of clinical decision support guidelines, readily available for use in the ED.
-Registration opens on 8th October 2013. Go to www.icem2014.org for more details.
* Please note: There is an event in London in Sept 2014 entitled 'IRCEM 2014', organised by the World Academy of Science, Engineering and Technology. This event is for scientists and is not related to the College or the International Federation for Emergency Medicine.
Sepsis is a significant cause of death and disability in the UK. The College welcomes the first clinical report from the Health Ombudsman that highlights the death of patients in the NHS after failure to diagnose and rapidly treat severe sepsis. It focuses on ten cases investigated where patients did not receive the treatment they urgently needed. In every case, tragically, the patient died.
The College welcomes the report Future hospital: caring for medical patients, which sets out the Commission’s vision for hospital services structured around the needs of patients, now and future. The Commission’s recommendations are drawn from the very best of our hospital services, taking examples of existing innovative, patient-centred services to develop a comprehensive model of hospital care that meets the needs of patients, now and in the future.
This GEMNet guideline has been rebised prior to publication in the EMJ.
The College of Emergency Medicine has provided direct input into the Review of Urgent and Emergency Care being led by Sir Bruce Keogh.
Read the report from Prof Don Berwick that highlights the main problems affecting patient safety in the NHS and makes recommendations to address them, stating that the health system must:
- recognise with clarity and courage the need for wide systemic change
- abandon blame as a tool and trust the goodwill and good intentions of the staff
- reassert the primacy of working with patients and carers to achieve health care goals
- use quantitative targets with caution - they should never displace the primary goal of better care
- recognise that transparency is essential and expect and insist on it
- ensure that responsibility for functions related to safety and improvement are established clearly and simply
- give NHS staff career-long help to learn, master and apply modern methods for quality control, quality improvement and quality planning
- make sure pride and joy in work, not fear, infuse the NHS
The College welcomes the government announcement of additional funding but calls for long term solutions.
The College has revised and updated our guidance for doctors undertaking CPD. The guidance describes how to plan, undertake and record effective CPD that enables doctors to maintain their fitness to practice.
The standards for the clinical structure and content of patient records were published in July 2013 by the Academy of Medical Royal Colleges. They were developed through extensive consultation to ensure that they address the requirements of clinicians, patients, carers and health information technology professionals.
The RCEM best practice guidance has been revised following the recent recommendations from the MHRA restricting the use of codeine in those less than 12 years old, following a review of safety.
The College has revised and republished this best practice guidance to include children and adolescents and the legal distinctions in Scotland.
*IMPORTANT: We recommend Fellows and Members in Scotland refer to the Mental Welfare Commission for Scotland publication Right to treat: http://www.mwcscot.org.uk/media/51822/Right%20to%20Treat.pdf
New guidance from the GMC and Medical Schools Council that includes suggesting preventative measures that may help to reduce mental health problems in their students, the use of occupational health and how to handle students with mental health conditions in relation to fitness to practise. It is also relevant to people and organisations involved in postgraduate medical education and training. http://www.gmc-uk.org/education/undergraduate/23289.asp
View the provisional programme for this exciting event. Registration is now open via booking form.
The College welcomes the report and calls for immediate action to reform urgent care and make careers in Emergency Medicine sustainable.
Following the closure of the NHS Institute for Innovation and Improvement, a variety of resources for Paediatric EM can now be found on the College website, including assessment tools, pathways, management plans, patient advice leaflets for specific conditions. www.collemergencymed.ac.uk/Shop-Floor/Clinical Guidelines/External Guidelines/Paediatric EM guidance (NHS Institute)
The Francis report has many recommendations for organisations as a result of the enquiry. The College has developed this checklist for Clinical Directors of the Emergency Department – taking the most relevant recommendations and identifying key actions for clinical leaders of emergency departments. While the list is not exhaustive it is meant as a handy guide to action that might usefully be taken in the first instance
Urgent and emergency care: a prescription for the future (18 July 2013)
The Royal College of Physicians, NHS Confederation, the Society of Acute Medicine and the College of Emergency Medicine have set out ten priorities for action to address the challenges faced by urgent and emergency care services. These challenges include:
- Rising demand and the changing needs of an ageing population
- Lack of comprehensive, effective alternatives to hospital admission across seven-days
- Complex discharge issues
- Handover and flow
- Recruitment into emergency and acute medicine
Second victims are health care providers who are involved in an unanticipated adverse patient event, in a medical error and/or become victims in the sense that they are traumatised by the event. The Safer Care SubCommittee has prepared a guidance document for supporting Emergency Department colleagues who experience such events. This guide advocates key recommendations for individuals and the senior team within the Emergency Department.
The College welcomes the GMC report and recommends that safe and sustainable working patterns for trainees and consultants must be found to be able to provide clinical care and time for supervision that reflects that intensity of work.
Care delivered in the urgent and emergency setting in England is increasingly important, and complex. Funding mechanisms need to be re-evaluated. Existing systems fail to adequately fund current care, and are not driving improvements in care. A fundamental change is needed so that resources are allocated to produce the most cost-effective outcomes.
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Doctors in training in the UK have historically started new six-monthly rotations in February and August, with the majority of junior doctors rotating to new training programmes during the first week of August. There is an increasing body of evidence to suggest that simultaneous trainee changeover is associated with higher mortality, reduced efficiency and lower satisfaction. The Academy of Medical Royal Colleges (AoMRC) and NHS Employers have worked with partner organisations to develop simple, practical recommendations that can help mitigate these problems.
The four key recommendations are recognised as best practice and could be implemented within the current arrangements:
1. Consultants must be appropriately available
2. Flexible and intelligent rota design
3. High quality clinical induction at all units
4. Reduction of elective work at changeover times
A report from Parliament - author Tobias Ellwood MP and Mark Philips. - In the aftermath of the London Olympics, which exposed gaps in overall response and recovery capability, resulting in bespoke, but temporary, resilience procedures. This paper considers the significant financial and operational efficiencies to be gained with simpler and strongerministerial leadership, streamlining of government policy formulation and unambiguous inter-agency operational command at both national and local levels.
The complete archive for the EMJ is now available to members at the site below: