Sustainability and Seven Day Services Taskforce Interim Report

Acute medicine

Acute medical units provide care for patients who present as medical emergencies or who develop an acute medical illness while in hospital. They play a crucial role in deciding the correct clinical pathway for such patients - whether that is discharge, transfer to a specialist ward or for the most severely ill patients transfer to a High Dependency Unit or Intensive care.

There is already considerable work underway in this area under the banner of the Unscheduled Care programme. The Scottish Government are working with NHS Boards to ensure that they have sustainable systems and processes for unscheduled care pathways which optimise patient care and satisfaction across the week. Having assessed their current services, each NHS Board has developed a Local Unscheduled Care Action Plan which identifies their priority areas for improvement. A number of the deliverables within the Unscheduled Care programme will support delivery of the sustainability and seven day services programme and are consistent with our focus on access to appropriate decision makers and timeous diagnostics. For example, there is a stream of work on Pro-active Discharge Management which seeks to eliminate unnecessary waits and delays both on the day of discharge and across seven days. Key to this is morning and weekend discharges, which require engagement with senior decision makers to provide daily ward rounds and with the range of other key clinical services such as Allied Health Professions (AHP), pharmacy, and diagnostic services, as well as transport and other support services. Communication across acute services and with community partners is key to ensuring patient flow and many initiatives to improve this are being implemented.

Similarly a number of Boards are carrying out work to better manage flow through their Accident Emergency Departments. This work focusses on appropriate assessment and diagnostics services being available to manage demand across time of day and day of the week.

As the Unscheduled Care programme moves into its next phase of activity, it will adopt a collaborative approach to leading improvement and building sustainability. It will do this by focussing on six essential actions to improving safety and patient flow across unscheduled care pathways. Seven day services has been identified as key across the essential actions.

With regard to pharmacy, the Scottish Government is considering the pharmaceutical care support and follow-up patients' needs either before discharge or post discharge. This would include, for example, medication reviews by pharmacists to ensure that patients are able to manage their medicines and get the optimum outcomes from their medicines whilst minimising harm, so that readmissions due to medication related causes are avoided. While this is relevant for Acute Medicine it is equally applicable to acute surgical discharge arrangements.

The Scottish Government and the Royal College of Physicians of Edinburgh are also undertaking a research project to evaluate Acute Medical care in Scottish hospitals which will help to inform our work. The project will consider the physical, process, procedural and personnel factors in each of 28 Acute Medical Units in Scotland. It will then analyse how the differing organisational factors relate to outcome data such as mortality rate, boarding/queuing rate, length of stay, readmission rate and direct discharge rate. It will also describe the current provision for seven day services within these medical units.

In addition, The Scottish Government is engaged on a national programme to improve patient flow, working initially on 4 pilot sites across Scotland (NHS Borders, NHS Tayside, NHS Forth Valley and NHS Greater Glasgow and Clyde). This includes identifying how existing weekday capacity can be better used to deliver services including elective surgery. It is seeking to identify how we can reduce any artificial variation that can have negative effects on how patients flow through the system and the quality and experience of care provided.

As we move forward we will wish to ensure that we link closely to these pieces of work.