Clinical standard 2: Time to first consultant review

Improving access to senior clinical decision makers and diagnostics seven days a week improvements

Royal United Hospitals Bath NHS Foundation implemented weekend consultant ward rounds, a seven day Emergency Surgical Ambulatory Care (ESAC) and an Assessment and Comprehensive Evaluation (ACE) of older people. These changes increased the availability of seven day access to senior clinicians and to diagnostics, reduced variation in the relative risk of mortality across the week, reduced the mortality risk at a greater rate than the national rate of improvement and reduced length of stay for frail older patients from 14.9 days in 2012/13 to 5.3 days in the first 6 months of ACE being implemented.

(Also under clinical standards 5 and 8).

Implementing a seven day ambulatory emergency care model

Southend University Hospitals Foundation NHS Trust has implemented a seven day ambulatory emergency care (AEC) model. Early specialist intervention and same day emergency care has reduced unnecessary admissions by at least 20%.

(Also under clinical standard 5).

Clinical engagement to achieve seven day services

Wrightington, Wigan & Leigh NHS Foundation Trust introduced seven day consultant and support staff presence in accident and emergency and the emergency and acute medical wards at from 2012. Strong clinical leadership was key and the improvements have resulted in the conversion rates in Greater Manchester (June 2015) and readmission rates which have reduced by 700 per annum.

Using audit cycles to embed seven day consultant reviews for emergency admissions

Dorset County Hospital NHS Foundation Trust undertook two consultant review audits, against the clinical standard 2 to identify areas for improvement. The audit cycle produced an increase in compliance with the clinical standard from 59% in surgery and 64% in medicine to 88% and 89% respectively.

One stop emergency surgery ambulatory care service commissioned for 7 days a week

Royal United Hospitals Bath NHS Foundation Trust commissioned Emergency Surgical Ambulatory Care (ESAC) for acute general surgical patients. 71% of patients were diagnosed and discharged on the same day with a planned operating date. Only 5% of patients required admission. The ESAC has released approximately 90 bed days per month.

(Also under clinical standards 5 and 8).

Improving access to consultant delivered care to avoid readmission of older people to hospital

Ashford and St. Peter’s Hospitals NHS Foundation Trust set up an interdisciplinary seven day Older People Assessment and Liaison Service (OPALS). This seven day interdisciplinary team, based on the medical assessment unit, assesses and creates a management plan for all older people potentially to be admitted to hospital . There have been significant reductions in readmissions to hospital from 21.7% to 15% as well as a reduction in length of stay from 10.1 to 9.1 days. Times for patients to be seen by a geriatrician within two hours of admission has improved from 0 to 77%.

(Also under clinical standards 3 and 9).