Vision for 2020 – The Royal College of Emergency Medicine

Over the past few years we’ve seen a year on year increase in patient attendances to ED and an increasing number of challenges, especially at winter. The Royal College of Emergency Medicine has produced some excellent videos on the challenges faced by EDs. If you would like to view the RCEM videos click here.

 

The RCEM ‘Vision for 2020’ is a great document to help us respond to these on-going challenges and one of the key proposals is to ‘recruit and retain a safe level of trained clinicians to meet the increasing demands’. One of the ways this can be achieved is by forming a broader clinical workforce which will include Advanced Clinical Practitioners. ACPs usually have backgrounds in ED nursing or the ambulance service.

 

I have been lucky enough to be invited to teach on our ACP training and was extremely impressed at the knowledge and quality of the clinicians attending. Sustainable workforce planning is high on our agenda and it’s always a pleasure to work with our ACPs on the shop-floor.

 

When we were designing SortED we were thinking about who would be in the best position to get the most out of an initial assessment for undifferentiated patients. The traditional Rapid Assessment and Treatment models are based on a Consultant led initial assessment. I’ve seen this work well in many departments, including my own, the only problem is the process can be quite variable. Some consultants really get the concept, others can find themselves drawn into the history and spending a long time with each patient. One of the key elements to SortED is that it helps to standardise the initial assessment process whilst also capturing a clinician’s intuition about the patient in front of them (that bit where your gut tells you that this patient is ‘sick’ even though they might have normal observations and not many red flag symptoms).

 

We were designing SortED with nurses/experienced clinicians in mind and it seemed natural to us that ACPs would be ideal for RAT. They’re experienced, confident, trained to assess patients holistically, have the ability to request imaging and are able to prescribe initial treatment. As many ACPs come for a nursing or pre-hospital background they also really grasp the concept of triage well. Also part of the RCEM’s Vision 2020 is to better to integrate the front door and equip EDs in their ability to ‘stream’ patients to the best treatment that meets their needs. SortED has a unique disposition tool (naturally called PlacED) that supports clinicians to make the right streaming decision for patients by using appropriate prompts.

 

It’s good to know that what we’ve designed is in-line with RCEM ‘Vision 2020’ (we’re not totally off piste!!).

 

Barbara Cleaver – Jul 2017