Emergency department capacity management: guidance
Guidance on developing a standard operating procedure to manage capacity and avoid crowding in the emergency departments.
6. Tips for implementation
These tips for implementation are based on learning from implementation across NHSScotland. The Scottish Government recognises that they represent good practice in guidance implementation and recommends their use by NHS boards.
1. Working group
The first step should be to form a short-life working group.
This will help focus direction and momentum and provide a forum for
engagement and a sense of shared ownership of
ED crowding.
2. Senior leadership
Strong senior leadership is essential for agreeing and
leading development of the standard operating procedure. This
should include chief executive, clinical leaders, managers and
directors, providing strong senior leadership and support for the
work.
3. Clinical engagement
It is vital that clinical staff are fully engaged. Clinical
leads from across all areas of the organisation should be members
of the working group, ensuring that progress is clinically led and
understood across the whole hospital.
4. Test and measure
Measures for eliminating crowding need to be agreed and
tested at local level. Having a quality improvement lead working
alongside a clinical lead helps ensure a robust process for
tracking and measuring cycles of change and testing measures, local
definitions and trigger points.
5. The 6 Essential Actions to Improving Unscheduled
Care
Successfully eliminating crowding relies on wider work
across the system to improve unscheduled care. It is crucial that
this work does not sit in isolation, but is considered within the
context of the 6 Essential Actions, particularly in relation to
daily site management and effective discharge planning.
6. Clinically agreed local definitions
There must be agreed clear definitions of what "crowding"
and "overcapacity" means locally, clearing any misconceptions staff
may have held prior to the work commencing. Defining terms helps
provide a structured framework for eliminating crowding at an early
stage, before the department reaches full capacity.
7. Clear decision matrices
Clear decision matrices with defined routes of action and
accountability in each department and aligned across the whole site
should be in place for occasions in which escalation is triggered.
Escalation steps should be agreed at executive director, management
and clinical levels.
8. Clinical responsibility
To ensure patients are kept as safe as possible at all
times, it is vital that clinical responsibility for individual
patients when handing over is clearly understood. Strong clinical
leadership and engagement should help support these
discussions.
9. Implementing stage 3
A recommendation to enact a full-capacity protocol should
only be made after the
ED lead nurse and
doctor have discussed the situation in detail with the site
director, lead nurse and lead doctor or on-call manager who, in
turn, will require the chief executive/medical director or formal
deputy (on-call director or deputy) to authorise any patient
movement out of the
ED to a full
ward.
This action, or any variation of a full-capacity protocol, is considered an exceptional response to untoward and unexpected circumstance to an immediate level 5 adverse event review.
Contact
Email: Alistair Pollock, Alistair.Pollock@Gov.Scot
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