A ‘coordinated approach’ is needed to support patients with urgent medical needs, say RCP

The Royal College of Physicians (RCP) and the Getting It Right First Time programme (GIRFT) have published a joint statement which recommends how to deliver the best possible care for patients who present with emergency and urgent medical needs.

The statement acknowledges that clinicians are under huge pressure due to the elective care backlog as well as an increase in urgent and emergency presentations, and for this reason the RCP say a ‘coordinated approach across medical specialities’ must be adopted to meet the needs of patients.

The statement sets out a series of recommendations which aim to help teams and individuals address day to day pressures in the clinical environment while acknowledging the differing experiences faced by organisations and their subsequent ability to make changes.

Recommendations from the statement focus on key areas including rapid access to a senior decision maker for specialty advice and assessment, ward-based care beyond acute medical units and virtual wards.

Rapid access to a senior decision maker

Firstly, the RCP and GIRFT programme emphasise the importance of ensuring acute medical units have adequate capacity and staffing to enable senior decision making throughout the entire 24 hours of the day.

They also recommend that in-reach to acute medical units by medical specialty teams should be a routine commitment each day, particularly for high-volume specialities such as cardiology, respiratory, geriatrics, gastroenterology and diabetes.

Furthermore, they suggest that access to telephone advice from a consultant in each medical speciality should be obtainable within 30 minutes. This is to ensure that appropriate pathways can be followed for patients presenting with urgent needs, including for patients who do not require admission.

Ward-based care beyond acute medical units

Secondly, the RCP emphasise the importance on ensuring that patients transfer to medical wards with the best specialty expertise to meet their needs.

This means that clinicians should work alongside bed management teams and operational managers to ensure that patients transferred from acute medical units are receiving appropriate specialty care when required. To enable this, the RCP say organisations need to use demand data to facilitate the best balance of specialty beds and resources.

They note that multi-specialty care will be required for some patients and clear responsibility for care coordination should therefore be in place, as shared care may be required for some patients.

To do this, they suggest the implementation of 7-day specialty consultant-led ward rounds which are delivered through coordination of the team, to ensure daily assessment and care planning, timely investigation and treatment, and discharge planning.

They note that resources should be efficiently used on ward rounds and should follow the RCP’s guidance on modern ward rounds, and emphasise the importance of having discharge and post-hospital early follow-up plans in place to ensure continued recovery.

Virtual wards

Finally, the RCP and GIRFT programme suggest clinicians make use of virtual wards, which provide daily assessment and coordination of care for people during acute illness, including physiological monitoring, and provide increased home care where required.

They highlight the importance of community- and hospital-based staff working together to provide appropriate care planning and delivery for people in their own homes during acute phases of illness and recovery, when this would reduce hospitalisation.

Since different models of care and levels of support for community-based practitioners by medical specialty teams are required for patients for whom hospital admission is avoided at acute presentation (step up) or early discharge is enabled (step down), they say both elements require formal planning within work plans, and supportive technology and administration.

Patients should receive appropriate care in the appropriate place and at the appropriate time”

The statement concludes: “Local clinical leaders, operational managers, system and network leaders must work together to prioritise improvements in care that move towards achieving these recommendations to meet patients’ and the healthcare system’s needs.

“Through implementation of these recommendations, patients should receive appropriate care in the appropriate place and at the appropriate time. It is important that physician activity is accurately job planned.

Joint national clinical lead for GIRFT (cardiology) and clinical vice president of the RCP, Dr Sarah Clarke said she hopes the recommendations will “support organisations to make improvements which will positively impact patient care.”

To read the full list of recommendations click here.