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Work begins to reshape the way Altnagelvin Hospital’s A&E department is run

A 24/7 phone service will be set-up to ‘keep the Emergency Department for emergencies’ and help it to operate more 'efficiently and effectively'

Altnagelvin A&E

Work has commenced on a project which aims to prevent overcrowding at Altnagelvin Hospital’s Emergency Department (ED).

The purpose is to direct people to the right services while keeping the ED for emergencies, ensuring it runs more ‘efficiently and effectively’.

Integral to that will be a 24/7 phone line, called Phone First, through which patients will be referred on to their GP, a ‘minors unit’ for minor injuries, wounds, musculoskeletal injuries or fractures, the ED itself if necessary or on to the most appropriate service.

Early analysis of Phone First in a neighbouring Trust area indicates that around one third of people attending ED departments could be treated elsewhere.

Ms Geraldine McKay, Director of Acute Hospital Services and Dr Ciaran Mullan, Strabane GP and Trust GP Associate Medical Director, presented a report titled ‘No More Silos’ to the Western Trust Board on Thursday.

It examines how Trusts can ‘protect and improve’ the delivery of urgent and emergency care.

The pandemic forced health professionals ‘to work outside their comfort zones’, Dr Mullan said, and when people ‘come out of their silos’ better outcomes can be achieved.

There is ‘ongoing pressure’ in emergency departments and an action plan was launched by the Department of Health in October.

As a result, a ‘No More Silos’ regional network was established.

Defining the core aims of the initiative, Dr Mullan said: “It is to introduce urgent care centres, these are alternative places for assessment that do not necessarily need an emergency department.

“The second is keeping emergency departments for emergencies, that speaks for itself, that’s what we want EDs to be there for not for other conditions that could be dealt with in a different place, more effectively and efficiently for staff and patients.

“Another aim is rapid access assessment and treatment services, this is essentially where we know a patient has an urgent need that would be better met by accessing a different service like physiotherapy or social services.

“A certain amount of these when there is an unscheduled need will end up in EDs.

“There is 24/7 telephone clinical assessment services.  This is based on a lot of what we’ve had to do with Covid which is try and plan care as best we can because of the Covid restrictions, and we know there are a lot of patients who will end up in an emergency department essentially because they feel they have no other option.

“This is to see if we can offer a phone service initially to try and plan the care of that patient, I’m not talking about emergency care, true emergencies will always have to come to an ED but this is urgent care where we can plan it and make it safer particularly in a climate with Covid restrictions.”

Other points were made including the need to manage and plan care for the frail elderly population and care home residents in a ‘proactive rather than a reactive way’.

AMBULATORY CARE

Ambulance arrival and handover zones for emergencies was also highlighted because that can become a challenge whenever EDs are busy.

In the Western Trust this is not a real issue at the moment, Ms McKay said, as the Trust has an average handover time of around 30-40 minutes compared to eight hours in other areas.

Work is ongoing to create an area specifically for ambulance handovers in conjunction with ‘interim expansion’ of Altnagelvin’s ED ahead of plans for a larger expansion in the future.

Ms McKay spoke about putting these aims into practice within the Trust.

She said the ambulatory care units at Altnagelvin Hospital and South West Acute Hospital (SWAH) are up and running and working well.

This unit allows patients who would normally be treated as inpatients to be seen as a day case.

Cardiology hubs have been set-up during the pandemic to improve rapid access and a cardiac health hub will be functional by the end of December at Roe Valley.

The 24-7 triage line is almost ready to be actioned but the Trust needs more call handlers and experienced senior nurses.

Causeway Hospital has piloted the Phone First project and have been receiving around 30 calls per day.

On average, a third of those calls do not need to attend ED and are redirected and the other two thirds are streamed into the ED to be seen by a clinician or into ED minor streams.

In terms of urgent care centres, she said there is a ‘real focus’ on utilising Omagh Urgent Care and Treatment Centre as an enhanced urgent care centre and the Trust is working towards a model whereby people can be streamed to that centre.

Additional key actions are making progress but ‘there is a lot more work to do,’ Ms McKay concluded.

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