Developing GP led Same Day Emergency Care (SDEC) in a District General Hospital

Dr Louisa Morris, General Practitioner and Clinical Lead for Quality Improvement, Prince Philip Hospital, Llanelli. Louisa.morris@wales.nhs.uk

Aims and Drivers

• Prince Philip Hospital (PPH) Llanelli is a 223 bed DGH within Hywel Dda University Health Board.

• PPH ‘Front of House’ consists of Acute Medical Assessment Unit (AMAU) and GP led Minor Injuries Unit (MIU)

• Pressures on existing services were analysed using retrospective data collection from Feb 19Feb20 (pre COVID-19)1

• New challenges Mar 20 onwards resulting from COVID-19 and social distancing requirements

• Medical Same Day Emergency Care (SDEC) proposed in order to address current pressures and improve patient care.

Methodology

• Business case (Oct20) for pilot funding from Welsh Government (WAG) until 31 Mar 21.

• HB continued funding thereafter.

• Engagement with key stakeholders.

• Initial location & staffing model agreed

• GP led model agreed.

• Patient selection based on clinical conversation, AMB3 score / NEWS4 score and set pathways.

• PDSA 1: Phase 1 pilot: 16-19 Nov 20 (8 hrs/day Mon-Fri).

• PDSA 2: Phase 2 pilot: 7 Dec 20 – ongoing (10hrs/day Mon-Fri).

• PDSA 3: Initial pathway based model moved to a process based model with defined exclusions.

• Patient feedback via central service accessed by QR code.

• Planned next PDSA cycles:

• PDSA 4: Introduction of Advanced Nurse Practitioner (ANP) from Apr 22.

• PDSA 5: Publicity campaign aimed at key stakeholders e.g. Primary Care / Ambulance / 111 total seen in SDEC.

• PDSA 6: initial triage of all medical referrals to hospital by SDEC clinician.

Primary Drivers: Reduce Overcrowding in Hospital.

Stream patients away from front door

Welsh National Metrics for Ambulatory Emergency Care were used to set aims2

•1. Phase 1 pilot (Nov 20)

• 2. Phase 2 (Dec 20)

• 3. Process based model (May 21)

•4. Introduction of ANP (planned April 22)

•5. Publicity camp