The second peak of the COVID-19 pandemic is putting a huge strain on hospital Emergency Departments (ED) up and down the country, as the normal surge in winter admissions is coupled with high rates of staff sickness and resources stretched further than ever before.
However, official NHS statistics show that a significant number of patients arriving at Emergency Departments (ED) do not need emergency care. This demonstrates that, somewhere in the triage and referrals process, there are breakdowns in communication and knowledge gaps that need to be fixed. In the era of COVID, the failure to triage patients before they come to ED puts patients at risk and puts additional burden on staff and facilities.
Patients are sent to ED through different routes - including from NHS 111, GPs in primary care and ambulance services. Effectively triaging these emergency referrals can be a complex process, and one that’s made more difficult when Primary Care clinicians cannot collaborate easily with their Secondary Care colleagues. However, Cinapsis’ work with NHS Trusts is evidence that, with the right digital communication tools, large numbers of emergency patients can be effectively managed away from ED and the burdens on Trust services reduced.
Same Day Emergency Care
A key goal of NHS England is to see an increase in the use of Same Day Emergency Care (SDEC) services to treat patients away from ED. SDEC services can be delivered in different ways, but are often ‘hot clinics’ where patients can receive necessary treatment or diagnostic assessment without an overnight admission. Examples of conditions which can be diverted to SDEC rather than ED include pneumonia, cellulitis and deep vein thrombosis.
Specialist Advice and Guidance
In order to successfully divert patients to SDEC services, GPs, paramedics, NHS 111 call handlers and other clinicians in primary care must have rapid and direct access to advice and guidance from Secondary Care specialists. Cinapsis puts approved digital communication tools into the hands of clinicians so that they can get the advice they need and make effective triaging decisions.
Ideally the advice will come from local consultants; however, this is not always possible where the local service is already overburdened. The Integrated Clinical Advice Network (ICAN), a new partnership between Cinapsis and ICS Insourcing, allows Trusts to draw on a national network of consultants who can provide advice to referring clinicians and support local services.
The ICAN enables GPs, paramedics and 111 responders to connect with specialists from the ICS network (who are subjected to ICS’s rigorous recruitment & compliance checks) for telephone advice and guidance or photo advice and guidance. With specialist advice and guidance, the GP or paramedic can action the best course of treatment for their patients, often avoiding an ED referral.
Securing better outcomes for all
When GPs and paramedics are supported in their triage decision-making, they are much less likely to send patients to ED. This means fewer patients in hospital where that can be avoided. Through Cinapsis, 83% of cases avoid ED attendance - 30% are managed in the community and 53% are either managed in SDEC units or managed through an elective care service.
A recent case study demonstrates the impact of instant-access communication tools on patient care.
A man with suspected TB who was waiting to be seen in Outpatients in 4 weeks' time came in on a Friday evening feeling really unwell. Before Cinapsis, I would have ended up admitting him [as a hospital inpatient]. I spoke to the Respiratory Consultant who made an appointment to see the patient the next morning in their Respiratory Hot Clinic. That was a really good experience for the patient and for the hospital it meant one less person in the A&E.
Because the GP could reach out to a Consultant for on-the-spot advice and guidance, the patient was successfully diverted to SDEC. A number of different stakeholders ultimately benefited from this scenario: the GP who was able to get advice quickly, the Consultant who could help their team by avoiding an emergency admission, the patient who benefited from receiving specialist advice quickly and avoiding having to be referred to ED, and the hospital ED staff who were able to dedicate resources to other patients instead. Cinapsis is delivering these benefits at scale across more than 20 clinical services.
Tackling the second peak
With ED service demand rising in parallel with COVID-19 cases, hospitals must act now to relieve the burden on their staff and free up inpatient beds for those in the greatest need. By putting in place the right digital tools to unite clinicians and frontline staff, NHS Trusts will be able to transform their provision of emergency care across the board.
We have seen the positive impact of specialist advice and guidance through our Cinapsis SmartReferrals platform, and are ready to support more Trusts across England to streamline their clinical communications. Please get in touch with a member of the team to find out more about Cinapsis, accessing the ICAN for your Trust or how we can help you enable Same Day Emergency Care.