1. DCHFT Emergency Department Update
Dr Rachel Wharton

2. Where to start?
Update on services first….. Then we can discuss some clinical stuff.

3. Staffing 8 ED Consultants (6WTE)
10 Middle Grades (+1 urgent care centre)
8 Junior Doctors (4xFY2, 4xGPVTS)
5 ENPs

4. Providing….. 24/7 medical cover at Specialty Doctor level
Consultant presence 9-9 Monday to Friday
Consultant presence 6 hours per day Sat and Sun
24/7 Consultant on call
ENP presence until 10pm

5. Dr Rachel Wharton
Dr Fred Cartwright
Dr Spencer Cheung
Dr Tamsin Ribbons
Dr Rob Torok
Dr Kevin Samarasingha
Dr David Markham
Dr Andy Brett

6. Our department Resus – 2 beds Majors – 7 beds
Minors – 5 assessment rooms plus plaster room
EDAU – 5 beds

7. EDAU 5 bedded area Maximum 12 hour stay Classically
chest pains awaiting 2nd troponin
Falls for OT/PT
Awaiting mental health review
Head injury observation
Awaiting CT (eg KUB or brain)
Patients needing just a little bit more observation before considering discharge (asthma, resolving headache, back pain)
Note recent Electronic Discharge Summaries (EDS) sent out with scant information; should be better going forward

8. ED Rebuild?
Detailed plans developed to increase physical size of department, including separate childrens area
Postponed (?indefinately) by CSR

9. Clinical Services Review
DCHFT to retain 24/7 ED
With 14 h per day consultant presence
DCHFT to retain trauma unit status
East Dorset to see changes to care offered by Poole and Bournemouth
Knock on effect of increased attendances at DCH estimated 5800 majors patients pa

10. IT developments Single sign on ED Virtual Board SWAST ECS
Replaces whiteboard
Allows better tracking of patients through ED
Allows extra info to GPs onto standard ED letter
SWAST ECS
No more green carbon copy sheets
Digital Patient record
In development

11. Major Trauma Part of Wessex trauma network (WTN)
DCHFT has best survival figures in the WTN
WTN consistently in top 5 performing networks in the country
ED consultant at all trauma calls

12. Other Emergency Clinical Services
Stroke thrombolysis (consultant led 24/24)
Primary PCI (M-F 9-5)

13. Urgent Care Centre Shared between DCHFT/DHUFT
Radiology extended 9-5 M-F and weekends
ED Middle grade plus Fred Cartwright providing clinical cover alongside GP colleagues

14. ED Performance
Failed to meet 95% target for last 3 quarters having met it for the 3 quarters prior to that
CQC report 2016 rated the ED as “requires improvement”

15. Our Challenges INTERNAL EXTERNAL Space in department Archaic IT
New Junior Doctor Contract
Inexperience of some Specialty doctors / recruitment and retention of this group
Fatigue within staff
Exit block (to wards and into community)
Space occupied by Specialty patients
Ambulatory care closed (re-opening M-F next week)
Increasing attendance
Loss of specialties (eg vascular, ?paeds/maternity)

16. What can we do for you?
And any questions?

17. Common Disasters Undiagnosed fractures Headache (SAH)
Scaphoid
Neck of femur
Vertebral column
Headache (SAH)
Ruptured achilles tendon (no such thing as “partial rupture”)
Abdominal pain in elderly (and the young)