HEAT T10 Mr David Chung Clinical Director, Emergency Medicine Ayrshire and Arran

Targets The Good “the 4 hour target”

Targets The bad – 5 Year plans – Great Leap Forward – HEAT H5? – HEAT H4?

Targets The Ugly – Vietnam War – “War on drugs” – Credit Crunch

Targets or Goals?

Emergency Medicine Provide care to undifferentiated self presenting patients, 24/7/365 No exclusions

What is unscheduled care If you can appoint, isn’t that planned?

ED Access Decide need Get thereBook in

Decide Need Phone Someone Appointed Wait Transport Book in

We are not contracted to provide care for minor injuries. If you have an injury please go the Accident Infirmary at the Victoria Infirmary.

Back to HEAT T10 What has this got to do with Emergency Medicine?

Role of Emergency Medicine To gather information To direct this to someone who can do something with it, possibly with advice To develop redirection pathways

Story so far Information – Demographics of attendees – Analysis of attendance to identify possible redirection

Demographic stuff Stewart Cardwell’s analysis of Ayrshire attendances – year olds make up 25.5% of workload – Of 79% are self presenters or 999 – Only 20% get admitted, 40% are discharged without review

Analysis Casenote review of 1733 patients, about 5- 10% of out of hours attendances should be primary care 2.5% attendances are psychiatric

Redirection pathways Currently: – Go to A&E For the future; – Back to relevant community based care

Potential progress Front door redesign Re direction Cross fertilisation

Changing behaviour Futile unless experiential learning – Advantages clearly demonstrated – Sanctions applied

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