1. REFORMING EMERGENCY CARE St. Jude's Past, present and future.

2. Summary The workload The good news The bad news The problems The solutions.

3. Workload. 67,000 new patients/ year (160-240/day). Increase of 4 % over last year. 16,000 hospital admissions Increase 7% over last year

4. The good news. Stable motivated workforce Improving local profile 69% of patients discharged/admitted within 4 hours of arrival. 96% of patients requiring admission admitted within 4 hours.

5. The bad news Still long waits at nights and weekends, this trend is getting worse Waits even for category 3 patients unacceptable at times (department judged unsafe 3 times in last winter) Some patients waiting more than 12 hours on trolleys although not 12 hour trolley waits???

6. Bad news Increasing numbers of medical patients diverted to A&E rather than wards due to bed problems Thrombolysis figure for the hospital poor (20% only with door to needle times < 30 minutes)

7. The problems Long trolley waits Long waits for minor injury Poor door to needle times

8. The solutions - trolley waits The solution to this is a matter for the whole hospital or even whole emergency system. The roots of the problem lie in under capacity Collaborative work with social services/primary care/acute medicine

9. Solutions - Minor waits Process re-design- empowered triage Minor illness to GP out of hours service Minor injury stream Nurse practitioner shifts weekends/ evenings

10. What we need. An end to trolley waits 4 nurse practitioners

11. Summary A&E problems the cardinal symptom of excess demand and under capacity The trolley wait problem needs a whole system approach to improve the situation Waits for minor injuries can be improved by re-design and nurse practitioners.