As the number of acute care hospitals reduces from 45 to 21, a “joint emergency department” has been created at each one. The joint emergency department manages patient flow promptly by putting the emergency care specialist at the front door, backed by new technology and implementing a “flowmaster” role.
The flowmaster uses real-time capacity management information to manage the work of the whole joint emergency department. Options open to the flowmaster include providing patients with:
▒ GP appointment
▒ Next day hospital outpatient appointment
▒ Community outreach service
▒ A&E appointment.
Citizens who present at A&E are redirected to the triage telephone system. If they need face to face secondary care treatment, they are offered an appointment. There are video links for remote consultations.
Prof. Mikkel Brabrand, A&E consultant in Southern Denmark’s university hospital, says that the joint emergency department works by bringing together experts in Emergency Medicine, Orthopaedics, Neurology, General Surgery and Urology, with separate assessment units for Cardiology, Obstetrics, Oncology, Haematology and Paediatrics. There is active bed and patient management, with senior staff ‘at the front door’. Capacity conferences happen twice per day.
According to Mikkel, there are a number of factors which contribute to the success of this model on the frontline:
▒ The importance of close collaboration with GPs
▒ The need to empower ambulances to navigate to the best destination for patients
▒ The need for relentless focus on bed management and escalation/de-escalation, and
▒ Recognition that the IT systems and the ‘flowmaster’ role are key.
The seamless flow of patient information is a crucial component that underpins the whole model.