1. Dr. Andrew Foulkes Medical Director Surrey and Sussex Area Team Clinical Senate Summit 10.09.14 A&E, Acute Medicine and the Medical Specialties

2. The Changing Front Door Acute and Emergency services in the “future hospital” are changing. Our patients rightly demand the provision of consistent, safe & high quality medical services 7 days a week, and at all times of the day and night. Early review by an experienced “front door” clinical decision maker (usually and consultant in A+E Medicine or consultant physician) improves outcomes.

3. Modern, sustainable front door services require: standardised working in depts. of Emergency and Acute Medicine. a sustainable workforce, capable of always responding to surges in demand. immediately accessible supporting services – ALWAYS including: X -ray, ultrasound, CT scanning and labs services, critical care, & specialist inpatient beds. if paediatrics, general surgery and orthopedics (or any combination) are not immediately available on site, care pathways must be in place which provide immediate management and safe transfer of patients with severe illness or injury.

4. A+E Departments In all A+E departments consultants should be working on the shop floor for a minimum of 16 hours a day, 7 days a week. In major centres, consultant presence should be for 24 hours a day. Adequate, flexible-staffing levels must always be in place to cope with surges in demand. A functioning network of emergency services must be available to all patients and include: tertiary centres, emergency medicine dept.(s), primary care, MIU’s, mental and community health care teams, allied health and social services.

5. Acute Medical Units Medical emergencies are most vulnerable immediately after admission; consistently provided early consultant review improves patient outcomes. All newly admitted medical patients should be managed in a highly organised front door area (also called an “Acute Care Hub”) and be always reviewed by a consultant within 12 hours of admission. To deliver appropriately timed clinical review by an appropriately skilled and experienced consultant, acute care hubs should be staffed by a mix of acute and speciality medicine consultants and their teams, with dedicated duties rostered together on successive days.

6. Managing patient need – first time, every time Early, front door consultant review, improves patient outcomes for patients but must be based on need. Older patients with multiple comorbidities should have early access to comprehensive geriatric assessment. All acute hospitals should have a dedicated on-site liaison psychiatry service, 7 days a week, for 12 hours a day, with appropriate access out of hours.

7. 7 Days Acute and Specialty Services Acutely ill patients should receive the same care at weekends and bank holidays as on a week day’s, with consultant review, access to multi-professional staff and diagnostic services available on a 7-day basis. There should be a consultant presence on wards over 7 days, to provide specialty-specific care whenever it is required.

9. Selected References – each included in the papers Emergency Medicine Consultants: Workforce Recommendations, The College of Emergency Medicine; 2010. Royal College of Physicians. Acute care toolkit 2: high-quality acute care. London: RCP, 2011. Future hospital: caring for medical patients. A report from the Future Hospital Commission to the Royal College of Physicians. London: Royal College of Physicians, 2013. Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis Derek Bell et al, Published: April 17, 2013 (IIb) Framework for Quality and Safety in the Emergency Department (2012): International Federation for Emergency Medicine.