THE EMERGENCY CARE CENTRE AT KENT & CANTERBURY HOSPITAL: A NEW MODEL OF EMERGENCY CARE IN THE NATIONAL HEALTH SERVICE (NHS), UK

摘要

Kent &Canterbury Hospital is one of three acute district generalhospitals in the East Kent Hospitals University NHS FoundationTrust (EKHUFT). The Emergency Care Centre (ECC) at Kent &Canterbury Hospital provides a new model of care in the NHS.This was established in February 2005 as a result ofreconfiguration of patient services within the East KentHospitals University NHS Trust (EKHUT). The ECC and itsdevelopment is in keeping with the Department of Healthpolicies (Reforming Emergency Care Agenda and the NHS plan)(1).The ECC at Kent & Canterbury hospital takes acute admissionsfor medicine, vascular surgery, and urology as well as providinga minor injuries unit. The focus of the ECC is to deliver effectivehigh quality patient-centered care through an integrated teamled by senior medical and nursing staff.The acute medical admissions at Kent & Canterbury account forabout one third of the total EKHUFT medical work load whilstA&E services continue to be provided at Margate and Ashford.The major difference between the previous Kent & CanterburyA&E and the current ECC is that staff (medical and nursing) ismedically orientated and patients are assessed rapidly byintroducing the concept of a single clerking proforma. Kent &Canterbury Hospital provides patient access to critical care,non-interventional coronary care, diagnostic radiology,laboratory services, and other specialties (such as renal,neurology, hematology, oncology, rheumatology, anddermatology). The Emergency Care Centre at Kent & Canterbury Hospital hasavailable a wide range of facilities including: ? A Resuscitation area with four beds. ? A Majors Bay with twelve beds. ? A Short Stay Ward of eighteen beds. ? An Ambulatory Care Centre. ? The Minor Injury Unit (MIU). The Acute Physicians in the ECC currently provide cover Mondayto Friday from 9am to 5pm and have developed regular medicalreview clinics. The Medical and Elderly Care consultants eachlead three ward rounds in every twenty-four hour period.Through the implementation of the variety of measuresoutlined above the ECC has achieved over 98% auditedcompliance over the past 10 years. Patients needing with aperiod of observation and/or assessment overnight aretransferred to the adjacent ward within the ECC under the careof the on-call team and are the either discharged admitted to appropriate wards in the hospital.There are increased benefits in the constant supervision of FY2doctors which has improved their medical training in importantskills including assessment, investigations and treatment ofpatients in the ECC. It is also possible that at the supervisor levelthe practical procedures to be taught under their supervision.The ECC is pivotal in junior doctor training as out lined inModernizing Medical Careers curriculum.A significant innovation has been the DVT1-3clinics (AmbulatoryCare Centre) which is a nurse-led service developed at Kent &Canterbury Hospital for the assessment and management ofdeep venous thrombosis (DVT). The service has been developedby close collaboration of Senior Nursing staff, Physicians in theECC, and Hematology Department. The clinic assesses andtreats patients within two hours. A patient care pathway with apredicted probability score for DVT has been developed.Patients are assessed, investigated (including blood test sandDoppler scan), and treated in a single visit. Medical review isconstantly available if deemed necessary. Through the setpatient group directions (PGDs) the nursing staff are able toprescribe the appropriate medications. FURTHER IMPROVEMENTS The services provided in the ECC are being constantly reviewedto assure maintenance of high standards of quality care in a safesetting. Regular meetings and audits are in place to addressclinical governance issues: ? Develop and enhance nursing staff skills to assess patients,request investigations, initiate treatments and implementnurse-led discharge of patients via the Ambulatory carecenter ? Protocol developed and be