10. Managing urgent and emergency activity

What is it?

Developing an integrated approach to urgent and emergency care, particularly emergency medical admissions to hospital, involving hospitals, community, primary and ambulance services through joint service planning and sharing of clinical information across different agencies.

Why is it important?

  • Urgent care services are currently often highly fragmented and generate confusion among patients about how and where to access care (Lattimer et al 2010).
  • Patients are frequently admitted to hospital when this is not clinically justified because of a lack of alternative options.
  • Poor sharing of information as patients move between different providers is a cause of significant failures of care (Gandhi 2005).
  • The growth of new forms of urgent care, such as walk-in and urgent care centres, has failed to reduce A&E attendances (Cooke et al 2004). These grew by 30 per cent between 2003/4 and 2011/12 (Department of Health 2011a).
  • New forms of urgent care have also failed to reduce emergency admissions, which continue to grow, rising by 5 per cent between 2008/9 and 2011/12 (Department of Health 2011d; 2012).

What is the impact?

  • Addressing poor practice, improving care continuity, and reducing the numbers admitted to hospital could have a significant impact on health outcomes.
  • Making the urgent care system easier to navigate would improve patient experiences substantially.
  • Integrated urgent and emergency care services that manage demand more effectively have the potential to be significantly more cost-effective than existing arrangements.

How to do it

Although the impact could be highly positive, redesigning the urgent and emergency care system is likely to be highly challenging. Specific actions for commissioners could include:

  • providing effective signposting to help patients choose the right service
  • ensuring that hospital and community services can adjust service levels in response to changes in demand, so that need and provision are kept in balance
  • ensuring that A&E departments adopt best practice for handling 'majors' including early senior review
  • ensuring that hospitals and local authority social service and housing departments work effectively together to reduce delayed discharges and shorten lengths of stay
  • mapping and analysing patient flows around the system to identify bottlenecks and the scope for changing pathways to reduce the use of hospitals and to ensure that there is sufficient capacity across the health and social care system.

Useful resources

For further information