Ambulatory emergency care

Research output: Contribution to conferenceAbstract

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Abstract

Background
Emergency Department (ED) crowding is an increasing problem internationally. Causes are complex but analysis in the UK points to patients waiting for admission or discharge predominating as opposed to increasing attendances or inappropriate use of services . Clinical teams specialising in Acute Medicine in the UK promote a model of care to manage patients without the need for admission into a hospital bed and limit attendance to ED - Ambulatory Emergency Care (AEC) . The Netherlands, Australia & New Zealand have taken a similar route by developing Acute Medicine as a speciality with Acute Medical Units (AMU) delivering care as an alternative to ED, but they have yet to evolve the model to provide AEC to the same spectrum of medical conditions as seen in the UK . This work evaluates what international teams looking to adopt the AEC model to improve ED flow and outcomes can learn from the UK experience.
Methods
International, systematic literature search of current evidence base in the delivery of AEC:-Emergency Care flowSystem-wide flow-System-wide costs-Patients outcomes - clinical & experience-Enablers and barriers to successful models-Comparable international models
Results
Search results did not yield many papers for review or to accommodate a full international comparison. Published evidence around AEC is lacking and, as a result, and there are no agreed measures of successful models of AEC. Evidence of success is limited to case studies, conference proceedings and local audit. Yearly snap-shop audit in the UK appear to show improvement in conversion of patients from in-patient to AEC assessment on arrival to hospital (bypassing beds) following uptake of the model, but no data concerning direct impact on system-wide or ED flow was available. No robust cost-effectiveness studies were found. Published evidence of patient satisfaction is limited to online, anecdotal reports, but the majority of reports are positive with most dissatisfaction resulting from lack of communication and long waiting times . Clinical outcomes are confined to indirect system-wide measures with no published evidence of clinical or quality outcomes of use to evaluate AEC models for further learning. No published studies of the international application of AEC were found for comparison. 
Conclusion
AEC is promoted as best practice in the UK to minimise hospital admissions, improve emergency care flow, reduce costs of admission, prevent harm by avoiding admission, and provide patient-centred care according to clinical need and patient preference. Evidence of conversion of care from in-patient to out-patient is clear and the philosophy of AEC holds promise for preventing unnecessary hospital admission but the current evidence-base to support the intended flow, cost, clinical & quality outcomes is lacking, highlighting the need for research in this emerging, internationally important field of practice.
Original languageEnglish
Number of pages1
Publication statusPublished - 11 Dec 2018
EventInternational Workshop on Emergency Department Optimisation - VU Medical Center, Amsterdam UMC , Amsterdam, Netherlands
Duration: 11 Dec 201812 Dec 2018
https://healthcarelab.ksri.kit.edu/english/194.php

Workshop

WorkshopInternational Workshop on Emergency Department Optimisation
CountryNetherlands
CityAmsterdam
Period11/12/1812/12/18
Internet address

Fingerprint

Emergency Medical Services
Ambulatory Care
Costs and Cost Analysis
Emergency
Medicine
Patient-Centered Care
Patient Preference
Patient Discharge
Patient Admission
Patient Satisfaction
New Zealand
Practice Guidelines
Netherlands
Cost-Benefit Analysis
Patient Care
Outpatients
Communication
Learning
Admission

Keywords

  • ambulatory emergency care
  • emergency department
  • accident and emergency
  • urgent care
  • healthcare
  • healthcare improvement
  • health care

Cite this

Irvine, N., Megiddo, I., & van der Meer, R. (2018). Ambulatory emergency care. Abstract from International Workshop on Emergency Department Optimisation, Amsterdam, Netherlands.
Irvine, Nicola ; Megiddo, Itamar ; van der Meer, Robert. / Ambulatory emergency care. Abstract from International Workshop on Emergency Department Optimisation, Amsterdam, Netherlands.1 p.
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abstract = "BackgroundEmergency Department (ED) crowding is an increasing problem internationally. Causes are complex but analysis in the UK points to patients waiting for admission or discharge predominating as opposed to increasing attendances or inappropriate use of services . Clinical teams specialising in Acute Medicine in the UK promote a model of care to manage patients without the need for admission into a hospital bed and limit attendance to ED - Ambulatory Emergency Care (AEC) . The Netherlands, Australia & New Zealand have taken a similar route by developing Acute Medicine as a speciality with Acute Medical Units (AMU) delivering care as an alternative to ED, but they have yet to evolve the model to provide AEC to the same spectrum of medical conditions as seen in the UK . This work evaluates what international teams looking to adopt the AEC model to improve ED flow and outcomes can learn from the UK experience.MethodsInternational, systematic literature search of current evidence base in the delivery of AEC:-Emergency Care flowSystem-wide flow-System-wide costs-Patients outcomes - clinical & experience-Enablers and barriers to successful models-Comparable international modelsResultsSearch results did not yield many papers for review or to accommodate a full international comparison. Published evidence around AEC is lacking and, as a result, and there are no agreed measures of successful models of AEC. Evidence of success is limited to case studies, conference proceedings and local audit. Yearly snap-shop audit in the UK appear to show improvement in conversion of patients from in-patient to AEC assessment on arrival to hospital (bypassing beds) following uptake of the model, but no data concerning direct impact on system-wide or ED flow was available. No robust cost-effectiveness studies were found. Published evidence of patient satisfaction is limited to online, anecdotal reports, but the majority of reports are positive with most dissatisfaction resulting from lack of communication and long waiting times . Clinical outcomes are confined to indirect system-wide measures with no published evidence of clinical or quality outcomes of use to evaluate AEC models for further learning. No published studies of the international application of AEC were found for comparison. ConclusionAEC is promoted as best practice in the UK to minimise hospital admissions, improve emergency care flow, reduce costs of admission, prevent harm by avoiding admission, and provide patient-centred care according to clinical need and patient preference. Evidence of conversion of care from in-patient to out-patient is clear and the philosophy of AEC holds promise for preventing unnecessary hospital admission but the current evidence-base to support the intended flow, cost, clinical & quality outcomes is lacking, highlighting the need for research in this emerging, internationally important field of practice.",
keywords = "ambulatory emergency care, emergency department, accident and emergency, urgent care, healthcare, healthcare improvement, health care",
author = "Nicola Irvine and Itamar Megiddo and {van der Meer}, Robert",
year = "2018",
month = "12",
day = "11",
language = "English",
note = "International Workshop on Emergency Department Optimisation ; Conference date: 11-12-2018 Through 12-12-2018",
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Irvine, N, Megiddo, I & van der Meer, R 2018, 'Ambulatory emergency care' International Workshop on Emergency Department Optimisation, Amsterdam, Netherlands, 11/12/18 - 12/12/18, .

Ambulatory emergency care. / Irvine, Nicola; Megiddo, Itamar; van der Meer, Robert.

2018. Abstract from International Workshop on Emergency Department Optimisation, Amsterdam, Netherlands.

Research output: Contribution to conferenceAbstract

TY - CONF

T1 - Ambulatory emergency care

AU - Irvine, Nicola

AU - Megiddo, Itamar

AU - van der Meer, Robert

PY - 2018/12/11

Y1 - 2018/12/11

N2 - BackgroundEmergency Department (ED) crowding is an increasing problem internationally. Causes are complex but analysis in the UK points to patients waiting for admission or discharge predominating as opposed to increasing attendances or inappropriate use of services . Clinical teams specialising in Acute Medicine in the UK promote a model of care to manage patients without the need for admission into a hospital bed and limit attendance to ED - Ambulatory Emergency Care (AEC) . The Netherlands, Australia & New Zealand have taken a similar route by developing Acute Medicine as a speciality with Acute Medical Units (AMU) delivering care as an alternative to ED, but they have yet to evolve the model to provide AEC to the same spectrum of medical conditions as seen in the UK . This work evaluates what international teams looking to adopt the AEC model to improve ED flow and outcomes can learn from the UK experience.MethodsInternational, systematic literature search of current evidence base in the delivery of AEC:-Emergency Care flowSystem-wide flow-System-wide costs-Patients outcomes - clinical & experience-Enablers and barriers to successful models-Comparable international modelsResultsSearch results did not yield many papers for review or to accommodate a full international comparison. Published evidence around AEC is lacking and, as a result, and there are no agreed measures of successful models of AEC. Evidence of success is limited to case studies, conference proceedings and local audit. Yearly snap-shop audit in the UK appear to show improvement in conversion of patients from in-patient to AEC assessment on arrival to hospital (bypassing beds) following uptake of the model, but no data concerning direct impact on system-wide or ED flow was available. No robust cost-effectiveness studies were found. Published evidence of patient satisfaction is limited to online, anecdotal reports, but the majority of reports are positive with most dissatisfaction resulting from lack of communication and long waiting times . Clinical outcomes are confined to indirect system-wide measures with no published evidence of clinical or quality outcomes of use to evaluate AEC models for further learning. No published studies of the international application of AEC were found for comparison. ConclusionAEC is promoted as best practice in the UK to minimise hospital admissions, improve emergency care flow, reduce costs of admission, prevent harm by avoiding admission, and provide patient-centred care according to clinical need and patient preference. Evidence of conversion of care from in-patient to out-patient is clear and the philosophy of AEC holds promise for preventing unnecessary hospital admission but the current evidence-base to support the intended flow, cost, clinical & quality outcomes is lacking, highlighting the need for research in this emerging, internationally important field of practice.

AB - BackgroundEmergency Department (ED) crowding is an increasing problem internationally. Causes are complex but analysis in the UK points to patients waiting for admission or discharge predominating as opposed to increasing attendances or inappropriate use of services . Clinical teams specialising in Acute Medicine in the UK promote a model of care to manage patients without the need for admission into a hospital bed and limit attendance to ED - Ambulatory Emergency Care (AEC) . The Netherlands, Australia & New Zealand have taken a similar route by developing Acute Medicine as a speciality with Acute Medical Units (AMU) delivering care as an alternative to ED, but they have yet to evolve the model to provide AEC to the same spectrum of medical conditions as seen in the UK . This work evaluates what international teams looking to adopt the AEC model to improve ED flow and outcomes can learn from the UK experience.MethodsInternational, systematic literature search of current evidence base in the delivery of AEC:-Emergency Care flowSystem-wide flow-System-wide costs-Patients outcomes - clinical & experience-Enablers and barriers to successful models-Comparable international modelsResultsSearch results did not yield many papers for review or to accommodate a full international comparison. Published evidence around AEC is lacking and, as a result, and there are no agreed measures of successful models of AEC. Evidence of success is limited to case studies, conference proceedings and local audit. Yearly snap-shop audit in the UK appear to show improvement in conversion of patients from in-patient to AEC assessment on arrival to hospital (bypassing beds) following uptake of the model, but no data concerning direct impact on system-wide or ED flow was available. No robust cost-effectiveness studies were found. Published evidence of patient satisfaction is limited to online, anecdotal reports, but the majority of reports are positive with most dissatisfaction resulting from lack of communication and long waiting times . Clinical outcomes are confined to indirect system-wide measures with no published evidence of clinical or quality outcomes of use to evaluate AEC models for further learning. No published studies of the international application of AEC were found for comparison. ConclusionAEC is promoted as best practice in the UK to minimise hospital admissions, improve emergency care flow, reduce costs of admission, prevent harm by avoiding admission, and provide patient-centred care according to clinical need and patient preference. Evidence of conversion of care from in-patient to out-patient is clear and the philosophy of AEC holds promise for preventing unnecessary hospital admission but the current evidence-base to support the intended flow, cost, clinical & quality outcomes is lacking, highlighting the need for research in this emerging, internationally important field of practice.

KW - ambulatory emergency care

KW - emergency department

KW - accident and emergency

KW - urgent care

KW - healthcare

KW - healthcare improvement

KW - health care

M3 - Abstract

ER -

Irvine N, Megiddo I, van der Meer R. Ambulatory emergency care. 2018. Abstract from International Workshop on Emergency Department Optimisation, Amsterdam, Netherlands.