Health - redesign of urgent care: evaluation - main report
The Redesign of Urgent Care pathway aims to improve patients’ access to urgent care. The evaluation captured patient and staff experiences of the pathway and analysed key urgent care delivery metrics, enhancing our understanding of what is working well and areas for improvement.
Footnotes
1 Redesign of Urgent Care Evaluation - Technical Report (Link opens in new window)
2 It is important to note that, as set out below, that the introduction of the RUC pathway, included Flow Navigation Centres (See Figure 2.1), which has created a new kind of attendance, often referred to as a planned attendance. This occurs when a patient is referred to A&E by the Flow Navigation Centre and is booked into a specific time slot at a specific location (i.e., as opposed to self-presenting which would be classified as an unplanned attendance). Up to December 2024, including the period covered by this evaluation, such ‘planned attendances’ have not been routinely or consistently recorded across different Health Boards. An updated approach to coding urgent care attendances will be introduced in February 2025 which will include a new ‘planned’ attendance code. An assessment of the impact of this change estimates a c.4% increase nationally in the total number of attendances, although the impact will vary across different Health Boards. This is covered fully in Section 3.5.3.
7 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
8 Please note: the focus of the Patient survey and the Discontinued Caller survey were on patient experience of the RUC (A&E) pathway and not the wider changes made as part of the redesign of urgent care.
9 This adjusted base excludes deceased patients and undelivered questionnaires.
10 SIMD was calculated by using the postcode lookup file available which organises postcodes into 5 bands (quantiles): Scottish Index of Multiple Deprivation 2020v2 postcode lookup file [Link opens in new window]
11 For the purposes of the analyses, White ethnic groups includes ‘White - Scottish’ and ‘White - other British’. 'Minority ethnic groups' includes: 'Irish', 'Polish', 'Gypsy/Traveller', 'Roma', 'Showman/Showwoman' and 'other white ethnic groups', 'Mixed or multiple ethnic groups', 'Asian, Scottish Asian or British Asian', 'African, Scottish African or British African', 'Caribbean or Black', 'Arab, Scottish Arab or British Arab' or any other ethnic groups. Ethnic group guidance [Link opens in new window]
12 Urban Rural Classifications in Scotland (Link opens in new window).
13 The ‘achieved sample’ is the respondents that completed a questionnaire (i.e., respondents).
14 In some cases, a donation was made to a charity associated with the participant’s NHS Board.
15 See Technical report, Section 10 for complete interview topic guide
16 Literature review of outcome studies in healthcare (Link opens in new window).
17 Margin of error, or confidence interval, is a statistical measurement of difference between survey results and the population value, expressed as a percentage. The margin of error measures the difference between the survey results and how accurately they reflect the views of the overall population; the smaller the margin of error, the more confidence you can have that the results are representative of the population.
18 Improved recording of A&E activity (Link opens in new window)
19 Source of data: NHS 24. See Technical Report, Section 4, Table 2.
20 Please note in this section the term A&E is being used to refer to the Emergency Department and is not being used as an umbrella term for both the Emergency Department and Minor Injuries Unit
21 In-hours refers to Monday-Friday daytime (8am-6.30pm). Out-of-hours refers to Monday-Friday evening/night (6.31pm-7.59am), Weekend daytime (8am-6.30pm) and Weekend evening/night (6.31pm-7.59am).
22 Secondary care endpoint refers to respondents accessing one of the following services: A&E, MIU, or 999 Ambulance Service.
23 Response option 3 (‘I went to an A&E Department’) and response option 4 (‘I went to a Minor Injuries Unit’) have been combined. Response option 6 (‘I contacted a pharmacist/chemist’), response option 7 (‘I contacted another healthcare professional’) and response option 10 (‘I contacted another service’) have been combined. Response option 8 (‘I looked on the NHS Inform website for information’) and response option 9 (‘I looked on another website for information’) have been combined.
24 Data collection for this survey was during a pre-election period and therefore the results should be interpreted with this in mind.
25 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window). Note this was based on all calls to NHS 24 and not just those calls to the RUC (A&E) pathway.
26 (Monday to Fridays 08:00:00 to 17:59:59, this includes any public holidays)
27 (Monday to Fridays 00:00:00 to 07:59:59 and 18:00 to 23:59:59)
28 (Saturday 00:00:00 to Sunday 23:59:59)
29 Caution should be applied when making any comparison between Table 5.2 and Figure 4.2 (self-reported wait before discontinuing a call by day/time of call). This is due to the differing: type of data (objective and self-reported respectively), samples and time periods.
30 Caution should be applied when making any comparison between Table 5.3 and Figure 4.2 (self-reported wait before discontinuing a call by day/time of call). This is due to the differing: type of data (objective and self-reported respectively), samples and time periods.
31 The day/time of call was based on NHS 24 data included in the sample of patients. A derived variable was created from recoding sample information on a) the date and b) the time the patient called NHS 24 into a new variable and consolidating the options into 4 groups (i.e., Weekday daytime, Weekday evening/night, Weekend daytime and Weekend evening/night).
32 Source: NHS 24 recorded endpoint included in the sample
33 Patient compliance with NHS 111 advice (Link opens in new window)
35 It is important to note that not all FNCs are providing consultations or care to patients; some FNCs provide an administrative function only.
36 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
37 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
38 The Kings Fund: Accident and emergency (A&E) waiting times (Link opens in new window)
39 Waiting times in emergency departments (Link opens in new window)
40 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
41 NHS Scotland performance against LDP standards (Link opens in new window)
42 Please note these are positive ‘scores’ which show the percentage of respondents that selected the most positive response option(s). Non-specific response options, such as ‘Don’t know/Can’t remember’ are excluded from the base. For more information, please see section 3.3.1 of the Technical Document.
43 Note: some findings were suppressed due to too few respondents in some endpoint categories
44 Findings are based on a derived variable which was a count of the number of the following services respondents said that they accessed: a service before NHS 24 111 (Q2), a call back from local health services (Q14), accessed A&E or MIU (Q23) and accessed another service (Q27).
45 Please note these findings are based on positive scores. Non-specific responses, such as ‘Don’t know/Can’t remember’ or ‘Not Sure’ are not included in the scoring.
47 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
48 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
49 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
50 NHS Scotland redesign of urgent care: second national staging report (Link opens in new window)
52 For the dependent variables used in the Interrupted Time Series Analyses, ’A&E’ refers to the collective term for Accident and Emergency services. It includes Emergency Departments, minor injury units and community A&Es or community casualty departments that are GP or nurse led. At some sites, A&E activity can also take place in trolleyed areas of assessment units, and this should be included in the reported A&E statistics.
53 Excluding COVID Hub. Assessment
54 Calculated by adding the start value of the delivery metric in a given time period (either pre- or post- period), to the trend of the given time period (either pre- or post- time trend) multiplied by 52 (representing the 52 weeks in a year period).
55 It was observed that the relative reduction in weekend referrals to SAS was proportional to the reduced number of weekend calls.
56 Self-referrals describe the patients that attend A&E services without referral from an alternate service (e.g., primary care or NHS 24 111).
Contact
Email: dlhscbwsiawsiaa@gov.scot
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