Nationally, emergency departments (EDs) are increasingly congested from rising demand and high hospital bed occupancy limits flow through the acute care pathway, leading to inefficiency, increases in breaches of the 4-hour ED target,1 and is associated with clinical risk to patients and staff as well as financial penalties for trusts.Ambulatory emergency care (AEC) offers one solution, to provide an appropriate support to primary care when escalation is needed, and to reduce the use of the inpatient bed-base,2,3 thereby facilitating more treatment of acute illness from a community setting. AEC is described as ‘… diagnosis, observation, treatment and rehabilitation, not provided within the traditional hospital bed base … and provided across the primary–secondary care interface, ’3 which means that ‘ patients … are … diagnosed and treated on the same day and then sent home with ongoing follow-up as required .’4AEC manages acutely unwell patients, often with undifferentiated illness, to establish a diagnosis or a point of clinical stability that enables patients to return to primary care. Use of the ED and potentially short admissions are avoided, while, possibly, improving the patient experience.2 While GPs are experienced in risk management with undifferentiated illness, AEC differs in that the acuity of illness is greater than in primary care and familiarity with intravenous (IV) treatment and interpretation of cross-sectional imaging are needed. But AEC models are relatively new, heterogeneous, and not fully understood. Here we conceptualise the role and position of AEC by considering patient journeys through the service and highlighting the areas in need of address to maximise its value moving forwards.AEC departments must rapidly differentiate syndromes in acutely unwell patients after referral from primary …
展开▼
