A high-level meeting of over 160 senior doctors, nurses and health professionals from around the UK, convened by the Royal College of Physicians of Edinburgh and the Scottish Government, has produced recommendations which have the potential to significantly improve the provision of urgent care for hospital patients throughout Scotland the UK.
The RCPE UK Consensus Conference on Patient Flow in Acute Medicine was convened against a background of medical and political uncertainty regarding how best to provide urgent care, ensure sufficient bed and staff capacity during times of pressure (particularly the winter) and to improve patient flow through, and experience in, hospitals. Over the course of the two-day meeting, held in Edinburgh on 15 and 16 November 2013, experts reviewed the available evidence (including emerging research which is still to be published). An independent, multi-disciplinary, panel (chaired by Nigel Edwards of the King’s Fund (and formerly the NHS Confederation)) then produced a consensus statement based upon this evidence, the delegates’ collective clinical experience and the consensus reached.
The Consensus Statement which was produced will now be passed to the Scottish and UK Governments and disseminated into clinical practice. Recommendations include -
The MDT must -
The recommendations about seven day working and boarding are particularly significant. Boarding occurs when wards or units are over capacity and a patient is admitted to another specialty ward that might not be best aligned to their care needs. In such cases this medical care is generally delivered by a consultant or team based elsewhere. Boarding has been an accepted practice within the NHS throughout the UK for managing high levels of unscheduled care during times of significant pressure, including winter. As a consequence of both an ageing population, and the development of more complex medical needs within this age grouping, frail, elderly patients have been disproportionately affected by boarding. In recent years there has been evidence to suggest that boarding has been increasing and that patients who are boarded have poorer outcomes including increased death rates, length of hospital stay and likelihood of readmission. The preliminary results of emerging evidence presented during the event, including a large-scale study of more than 2.5 million hospital admissions in Scotland supported by the Scottish Government, has consolidated these earlier findings.
Boarding is also seen as a symptom of wider underlying pressures within the hospital system including inappropriate hospital admissions; inefficient operational systems, planning and communication; workforce shortages; and delayed discharge arising from inadequate social care support in the community to support timely discharge. It has now been recognised that a change in culture and practice is required and that the NHS should declare its ambition to eliminate boarding as part of system-wide change. This will require significant changes in practice including the introduction of genuine 7 day working in hospitals to ensure that patients receive optimal care regardless of when they require it.
Nigel Edwards, King’s Fund, and Chair of the RCPE Consensus Panel, said,
“Growing demand from an ageing population with increasingly complex care needs bring both challenges and opportunities for the NHS. It is clear that in seeking to respond to the urgent care needs of this population fundamental change is required. This will involve changing how the NHS configures and delivers acute medical services and, in this post- Mid Staffordshire era, encouraging the NHS to have the ambition to eliminate established practices which are known to have adverse effects on patients and their experiences. Only by doing this can we hope to ensure that patients receive the quality, safety and dignity in patient care required.”
Dr Mike Jones, Vice President of the Royal College of Physicians of Edinburgh, said,
“The consensus reached at this event has the potential to significantly change how we deliver urgent medical care to patients throughout Scotland and the UK, and to improve the quality of care for patients and their experience while in hospital. As much as we would like to end the practice of boarding, this cannot be done overnight. We also have to recognise that boarding is a symptom of wider underlying systems problems and pressures within the NHS which have to be looked at collectively. This is why it is imperative to look at how we can improve the wider patient flow within hospitals and into the community. It is clear that the time has come for seven day working to be introduced to provide the level of care that patients require and doctors, nurses and health professionals wish to deliver. The Scottish Government should be applauded for supporting this event, related studies and work streams, given the potentially significant resource implications which could be involved in delivering an adequately staffed and genuine seven day service for patients. We would urge the Scottish and UK Governments to recognise the consensus reached and to support the implementation of these recommendations into practice”.
A Scottish Government spokesperson said,
“We are delighted to be supporting this major event which we believe will provide real benefits for patients. The Scottish Government, working with the Royal College of Physicians of Edinburgh, is leading the way within the UK, in tackling the problems associated with boarding and patient flow”.
“The discussion that has emerged from this collaborative event will help to inform the work that we are already taking forward to improve how patients flow through the entire healthcare system, and we will be considering these recommendations in detail”.
“We are already undertaking a wide-ranging programme of initiatives to improve flow throughout the whole system, which will help to free up beds and ensure patients can be put in the most appropriate ward for their treatment. We have invested £50 million in our unscheduled care action plan which is making improvements to the whole healthcare system to ensure patients can be seen and treated quicker, and we are investing £4 million in testing innovative new models of healthcare for the flow of patients.”
Contact: Graeme McAlister (RCPE) on 07733-263453 / Aileen MacArthur (Scottish Government) on 0131-244-2968 or 07747-790476
