Acute Liaison Principal

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Acute Liaison Principal

• Peter Slane
• Acute Medical Unit
• Ninewells Hospital Dundee
• Erskine Practice
• Arthurstone MC Dundee

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Acute Liaison Principal

• Background
• Roles/ responsibilities
• Unscheduled care

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Background

• Tayside Acute Services Review
• problems at interface
• GP in acute medical unit beneficial

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Acute Liaison Principal

• October 2000
• 4 sessions per week
• Funding initially from LHCC
• GPWSI? - salaried post?

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Acute Liaison Principal

• Primary care perspective
• Informing GPs / improving access
• Service Development - local/national

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Primary care Perspective

• Post take ward rounds
• Advice to triage nurses
• Improving anticoagulant care
• Out patient DVT assessment
• Electronic discharge document
• MOPD referral review

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Informing GPs/ improving access

• Alternatives to admission
• Acute Medical Clinic
• Nurse Triage / advice
• Chest pain guidelines
• CT, bone scan access
• ID access to facilitate OPHAT rx

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Service development

• Intermediate care facilities in Dundee?
• OOHS development
• MPJIN
• Unscheduled Care

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Collaboration

• ALP part of a multidisciplinary team
• Work closely with clinical director and nurse
  consultant in acute receiving
• Ward 14 patients

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ESDS effectiveness
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Unscheduled Care

• QIS - Emergency medical admissions scoping
  group july 2004
• CCI - Unscheduled care collaborative programme
  may 2005

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Programme Aim

• Improve patient and carer experience and
  satisfaction through improving access and
  reducing waits and delays across unscheduled care
  patient flows

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Outcome

• Achievement of maximum 4 hour emergency
  waiting time target by December 2007

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Important Facts about Medical referrals

• 10-20 do not require admission
• 10-15 stay less than 1 day
• 30-50 stay less than 3 days
• Over 60 of admissions are for chronic diseases
  and diseases of old age
• Many of these can be prevented
• The period of acute illness is short

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Unscheduled care flow groups

• Group 1 - minor injury and illness
• Group 2 - acute assessment
• Group 3 - medical admissions
• Group 4 - surgical admissions
• Group 5 - out of hospital care
• PDSA

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Unscheduled care / ward 15
admissions

• Range 18-55
• jan 37, feb 38, mar 38, apr 38, may 35
• 95 of busiest days, Monday/ Friday or post
  public holiday
• forward planning???

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Unscheduled care

• Estimated date of discharge
• Increased use of ward 14 and discharge lounge
• Acute medical team
• Weekend discharge PDSA
• PCLN discharge planning

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GP role in unscheduled care ?

• decide to admit NOT admit to decide
• use pro-forma letters
• specify reason for admission
• tell the truth
• send medicines with patient
• case management
• communicate with OOHS/NHS24

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M.R. age 86 year

• Lives alone
• 4 admissions in 3/12, frequent boarding in NW
• known angina/ GORD
• family concerned

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Acute Liaison Principal

• Unique position working within primary and
  secondary care, across the interface allows
  support to both disciplines and the experience
  gained is invaluable in informing the development
  and organisation of acute medical care in Tayside

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Acute Liaison Principal

• peter.w.slane_at_tuht.scot.nhs.uk
• bleep 4217