Ambulatory emergency care – improvement by design

Hamad, Mahir M.; Connolly, V.

doi:10.7861/clinmedicine.18-1-69

Cited by 24 publications

(25 citation statements)

References 10 publications

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“…There are an increasing number of acute cancer presentations that can be risk assessed for care in an emergency ambulatory setting. These include low-risk febrile neutropenia, cancer-associated deep vein thrombosis, incidental pulmonary embolism, chemotherapy-related acute kidney injury, chemotherapy-induced nausea and vomiting, indwelling line infections, acute management of pain crises, malignant hypercalcaemia and other electrolyte abnormalities, asymptomatic brain metastases and malignant pleural effusion [ [43] , [44] , [45] , [46] ].…”

Section: Interface With Acute Oncology – Ambulatory Supportive Carementioning

confidence: 99%

Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as ‘the prevention and management of the adverse effects of cancer and its treatment’. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.

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Section: Interface With Acute Oncology – Ambulatory Supportive Carementioning

confidence: 99%

Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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“…l The role of technology and health informatics, briefly touched on by this report, requires further examination, particularly relating to the identification and co-ordination of frequent users. 64 l The findings of the review further indicate the potential for realist evaluation approaches, 63,65,66 especially as several interventions identified seem to be heavily context dependent.…”

Section: Recommendations For Researchmentioning

confidence: 87%

“…l The review found that interventions specifically targeting the vulnerable groups identified in this report need to be co-designed, 64 developed, trialled and rigorously evaluated. A particular need was identified for further research on the clinical effectiveness and cost-effectiveness of promising UK initiatives.…”

Section: Recommendations For Researchmentioning

confidence: 99%

Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review

Preston

Baxter

Wong

et al. 2019

Health Serv Deliv Res

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Background The NHS currently faces increasing demands on accident and emergency departments. Concern has been expressed regarding whether the needs of vulnerable groups are being handled appropriately or whether alternative methods of service delivery may provide more appropriate emergency and urgent care services for particular groups. Objective Our objective was to identify what interventions exist to manage use of the emergency and urgent care system by people from a prespecified list of vulnerable groups. We aimed to describe the characteristics of these interventions and examine service delivery outcomes (for patients and the health service) resulting from these interventions. Review methods We conducted an initial mapping review to assess the quantity and nature of the published research evidence relating to seven vulnerable groups (socioeconomically deprived people and families, migrants, ethnic minority groups, the long-term unemployed/inactive, people with unstable housing situations, people living in rural/isolated areas and people with substance abuse disorders). Databases, including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature, and other sources were searched between 2008 and 2018. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. In addition, we searched for UK interventions and initiatives by examining press reports, commissioning plans and casebooks of ‘good practice’. We carried out a detailed intervention analysis, using an adapted version of the TIDieR (Template for Intervention Description and Replication) framework for describing interventions, and an analysis of current NHS practice initiatives. Results We identified nine different types of interventions: care navigators [three studies – moderate GRADE (Grading of Recommendations, Assessment, Development and Evaluations)], care planning (three studies – high), case finding (five studies – moderate), case management (four studies – high), front of accident and emergency general practice/front-door streaming model (one study – low), migrant support programme (one study – low), outreach services and teams (two studies – moderate), rapid access doctor/paramedic/urgent visiting services (one study – low) and urgent care clinics (one systematic review – moderate). Few interventions had been targeted at vulnerable populations; instead, they represented general population interventions or were targeted at frequent attenders (who may or may not be from vulnerable groups). Interventions supported by robust evidence (care navigators, care planning, case finding, case management, outreach services and teams, and urgent care clinics) demonstrated an effect on the general population, rather than specific population effects. Many programmes mixed intervention components (e.g. case finding, case management and care navigators), making it difficult to isolate the effect of any single component. Promising UK initiatives (front of accident and emergency general practice/front-door streaming model, migrant support programmes and rapid access doctor/paramedic/urgent visiting services) lacked rigorous evaluation. Evaluation should therefore focus on the clinical effectiveness and cost-effectiveness of these initiatives. Conclusions The review identified a limited number of intervention types that may be useful in addressing the needs of specific vulnerable populations, with little evidence specifically relating to these groups. The evidence highlights that vulnerable populations encompass different subgroups with potentially differing needs, and also that interventions seem particularly context sensitive. This indicates a need for a greater understanding of potential drivers for varying groups in specific localities. Limitations Resources did not allow exhaustive identification of all UK initiatives; the examples cited are indicative. Future work Research is required to examine how specific vulnerable populations differentially benefit from specific types of alternative service provision. Further exploration, using primary mixed-methods data and potentially realist evaluation, is required to explore what works for whom under what circumstances. Rigorous evaluation of UK initiatives is required, including a specific need for economic evaluations and for studies that incorporate effects on the wider emergency and urgent care system. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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“…7 AEC can be an effective way to treat patients outside of an inpatient setting and reduce burden on the acute hospital, and much work has been undertaken to help clinicians identify those patients who could be suitably treated in an ambulatory capacity. 8,9 Operational research approaches, such as the simulation modelling described in this paper, can further help to ensure that AEC units are able to maximise the benefit for both patients and the health service. We would encourage other service improvement staff to consider using such methods to help inform the delivery and redesign of their AEC services.…”

Section: Discussionmentioning

confidence: 99%

Using computer simulation to model the expansion needs of the ambulatory emergency care unit at Derriford Hospital

Chalk

2020

Future Healthcare Journal

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Ambulatory emergency care (AEC) units can treat a wide variety of patients referred from the emergency department (ED) and acute general practitioners, helping to ease ED pressures and reduce unnecessary hospital admissions. We developed a simulation model to assess the potential benefi ts of expanding the size and opening times of the AEC unit at Derriford Hospital in Plymouth, both separately and in combination. The model predicted that an expanded size of AEC unit could help to improve the effectiveness of the unit, but not as much as extending the opening hours of the unit, which was predicted to result in a signifi cant impact on the number of patients that can be seen and treated in the AEC unit. The hospital used the evidence generated by the model to support a business to case to extend opening hours of the AEC unit, and open the AEC unit at the weekend.

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Ambulatory emergency care – improvement by design

Cited by 24 publications

References 10 publications

Supportive Care: An Indispensable Component of Modern Oncology

Supportive Care: An Indispensable Component of Modern Oncology

Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review

Using computer simulation to model the expansion needs of the ambulatory emergency care unit at Derriford Hospital

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