Emergency Department signposting/ redirection guidance

7. Key Principles and Definitions

The following four key principles reflect best practice and are the basis from which to develop a signposting approach. They are written acknowledging that local interpretation and variation is likely however it is recommended a consistent approach is agreed and implemented.

The principles recognise Emergency Medicine as a specialty and that Emergency Consultants are trained specifically to provide emergency care in accordance with RCEM’s definition of Emergency Medicine.

7.1 Principles

Principle 1 - Patients receive the right care, at the right place, at the right time

• Patients self-presenting at Emergency Departments (ED), with a condition not requiring emergency care will be clinically assessed by an appropriate clinician for potential signposting/redirection.
• Where a formal referral from a non-healthcare professional has been made, patients will be registered and, following a timely initial assessment, a senior clinical decision maker will discuss the reason for attendance with the patient and may provide self-care or signposting/redirection advice if considered to be appropriate. If a patient has been formally referred by NHS 24 111, the source of the referral should be taken into consideration in the signposting/redirection process.
• Availability and effective use of Professional to Professional communication prior to presentation will avoid further need for patient signposting/redirection and local pathways should reflect the importance of making this easily available.
• Geographical location to be considered when signposting/redirecting a patient to the right place for ongoing care.

Principle 2 - Ensuring patient and staff safety

• Clinical decisions should involve patient interaction and be underpinned by good practice and care governance processes while being mindful of reducing health inequalities and meeting the needs of the wider population
• It is important that all staff within EDs apply a consistent approach to the application of the signposting/redirection guidance
• Appropriate and robust clinical governance should be in place which includes the ability to share learning from events and provide feedback with the aim of improving patient and staff experiences. This includes the ability to review and discuss cases, outcomes and share learning.

Principle 3 - Providing effective staff and patient education and communication

• Ensure communication is appropriate to the individual’s understanding. Use positive language when undertaking a signposting/redirection consultation and providing subsequent care advice.
• Ensure resources are in place to support signposting/ redirection using leaflets, web-links or telephone numbers
• In the Out of Hours (OOH) period, if it is assessed the patient is not in need of emergency or urgent support, it is appropriate to advise them that they should access services via their own GP practice/other non-emergency services in-hours.
• Where there is considered to be an urgent need which would be more appropriately managed by the OOH General Medical Service (GMS), this should be facilitated via a professional to professional call with the respective OOH service and the patient redirected accordingly. (In many areas, local pharmacies can provide minor ailment/other support in the out of hours period – including weekends - and these should form part of the list of alternative services available to refer to.)
• Safeguarding and redirection to social services should be considered. Provision of good local knowledge to support effective signposting/redirection is essential.
• NHS Boards, Medical Directors, Senior Executives and local teams should provide explicit support for all staff in local board EDs to signpost and redirect confidently. This should also be publicised via signage in the Emergency Department.
• Each Health Board or H&SCP should provide a basic directory of approved local services to include appropriate contact details to facilitate signposting/redirection.

Principle 4 - Sustaining and maintaining services and patient flow

• Resources including the provision of appropriately skilled ED staff (Medical, Nursing, AHP’s and non-clinical etc.) are required to sustain new models of working and ensure staff are available and have time to appropriately signpost/redirect patients.
• EDs will be required to review current staffing patterns and redesign accordingly to support the delivery of signposting and redirection.

Guidance Note:

Geography and availability of other services should be considered when signposting and redirecting patients, particularly in remote and rural locations. The range of facilities available to Emergency Departments will differ in and out of hours; it is acknowledged that this will impact on the implementation of signposting/redirection at different sites. However, this will provide an opportunity to highlight areas where extended or additional operational hours, or availability of alternative services will help to expand the range of signposting/redirection options.

In line with the requirements of the general equality duty as set out in the Equality Act 2010 you should consult and evaluate the impact of your local policy on your community to ensure this does not cause any disadvantage to others, and in particular those with protected characteristics. Thereby ensuring that the policy does not discriminate unlawfully; consider how the policy might better advance equality of opportunity; and consider whether the policy will affect good relations between different groups. The national team will extend the published iterative Redesign Urgent Care Equality Impact Assessment (EQIA) to consider the national impact.