Service/
intervention/
workstream/
treatment | Category | Rate of
deterior-
ation
(typically) | Impact of
doing
nothing | Maximum
deferral
period | Current
delivery
setting(s) | Current
delivery
personnel | Impact on
other services
(upstream and
downstream) | Alternative
delivery
setting(s) | Alternative
delivery
personnel | Impact on
other
services
(upstream and
downstream) |
|---|
Single morbidity assessment: Emergency Medicine Department |
|---|
Cardiac Arrest | ILT | Rapid | Death | None | Community ED MAU Hospital ward/
departments | Paramedics EMed and General medical staff Nursing staff | Community CCU, ITU Cardiology Rehabilitation service Pharmacy Mortuary Medical wards Pathology | Home Survivors only to hospital Any medical bed Hospital at home or their residential care home for elderly survivors Direct to specialist cardiology hospitals | Paramedics Medical and nursing staff Supervised HCA Need to be robust and sensible end of life discussions for appropriate patients with a system that ensures widespread communication of these decisions | As before Cardiology services |
Multiple trauma | I LT | Rapid | Death | None | ED | Paramedics EMed staff Trauma team | Community Radiology Theatres Critical care Surgical wards Rehab services Pathology Blood transfusion service | None | None | As before |
STEMI | ILT | Rapid | Death | None | Community ED MAU | Paramedics EMed staff Acute med staff Chest pain nurses Cardiology medical staff | Community CCU Pharmacy Angiography suite Cardiac rehab services Pathology | Community Direct admission to specialist cardiology hospitals Any available bed in hospital | Paramedics GPs | As before |
NSTEMI | ILT | Not predicted | Severe | 6-24hrs | ED MAU | Paramedics EMed staff Acute med staff Chest pain nurses Cardiology medical staff | Community CCU Pharmacy Angiography suite Cardiac rehab services Pathology | Community Direct admission to specialist cardiology hospitals | Paramedics GPs Cardiology | Pharmacy Pathology |
Arrhythmia
eg VT | ILT | Rapid | Death | None | ED MAU | Paramedics EMed staff Acute med staff Chest pain nurses | Community CCU Medical wards Cardiology Pathology Pharmacy | Community ED MAU Direct to specialist cardiology hospitals | Paramedics EMed staff Acute med staff | As before |
Arrhythmia
eg AF | Emergency | Moderate | Severe - Moderate | 6-24hrs | ED MAU | Paramedics EMed staff Acute med staff Chest pain nurses | Community CCU Medical wards Cardiology Pathology Pharmacy | Community Specialist cardiology hospitals | Paramedics GP Cardiology | Pharmacy Pathology |
Sepsis | ILT | Rapid | Death | None | ED MAU | EMed staff Acute med staff | Critical care Medical wards Pharmacy Radiology | Critical care Any available bed | Hospital at home service (for elderly) Hospital staff | Pharmacy Pathology Radiology |
Pneumothorax | ILT | Rapid | Moderate | None | ED MAU | EMed staff Acute med staff | Respiratory service (wards & OPD) Radiology | ED Home Any medical bed | EMed staff GP Community respiratory team OP F/U | Radiology Chest drain |
Significant Overdose | ILT | Not predicted | Death/ Severe | None | ED MAU | EMed staff Acute Med staff | Paramedics Critical care Pharmacy Pathology Psychiatry Medical or CDU bed | Some investigate and treat in community Others ED | Paramedics GP ED/Medical staff | Pharmacy Pathology Community nurses HTT TOXBASE |
Minor Overdose | Emergency | Slow | Mild | None | ED | EMed staff | GP surgery Psychiatry liaison Pathology Pharmacy | Community MIU | Paramedics GP HTT | Pharmacy Pathology Access to TOXBASE |
Physical self harm (minor) | Semi urgent | Slow | Mild | 6-24hrs | ED GP surgery MIU | EMed staff GP | Psychiatry Procurement Radiology | Community MIU | Paramedics GP HTT | Wound Care supplies |
Sprain | Emergency | None | Mild | 24hrs-3 days | ED GP surgery Physiotherapy surgery MIU | EMed staff GP Physio-therapists | Radiology Medical supplies Pharmacy Physiotherapy | Community MIU | GP Physiotherapy | Pharmacy Medical supplies crutches etc |
Simple laceration or incised wound | Semi-elective | Slow | Mild | 6 hrs | ED GP surgery MIU | EMed staff ENP GPs | Radiology Medical supplies Pharmacy | Community MIU | GP ENPs Self Paramedic | Radiology Medical supplies Pharmacy |
Complicated laceration | Emergency | Moderate | Moderate | None | ED | EMed staff Plastic surgery Orthopaedics | Radiology Medical supplies Pharmacy Operating departments OPD | Community Direct to OPD | GP Plastics Orthopaedics | Radiology Medical supplies Pharmacy |
Fractures - Simple e.g. buckle | Emergency | Slow | Mild | 6-24hrs | ED MIU | EMed staff Orthopaedics ENPs | Radiology Fracture clinic Medical supplies Pharmacy | Community MIU (after radiology) | GP Orthopaedics ENPs | Radiology Supplies of splints |
Fractures - complicated | ILT | Rapid | Death - severe | None | ED | EMed staff Orthopaedics Plastic surgery | Radiology Operating departments Orthopaedic wards | Hospital Could aim for earlier hospital discharge with home physio and iv antibiotics | ED medical staff Orthopaedics | As before |
Dislocation - simple | Emergency | Moderate | Moderate | None | ED MIU | EMed staff Orthopaedics ENPs | Radiology Fracture clinic Medical supplies | Community (after radiology) | GP Orthopaedics ENPs | Radiology Supplies of splints |
Dislocation - complicated | Emergency | Rapid | Severe | None | ED | EMed staff Orthopaedics ENPs | Radiology Operating departments Orthopaedic wards Vascular surgery Occ Medical supplies pharmacy | Hospital Could aim for earlier hospital discharge with home physio etc | ED medical staff Orthopaedics Vascular surgery | As before |
Burns - minor | Semi-elective | Slow | Mild | None unless self treated | Home GP MIU ED | Self GP Paramedic ENP EMed staff | Pharmacy Medical supplies | Home GP MIU | Self Paramedic GP Nurse MIU | Pharmacy Medical supplies |
Burns - major | ILT | Rapid | Death | None | ED | EMed staff +/- Anaesthetic staff | Paramedics Critical care Plastic surgery Pharmacy Medical supplies Operating department | ED or Direct to local burns unit | EMed staff Paramedic Plastic surgery staff | Paramedic Critical care Plastic surgery Pharmacy Medical supplies Operating department |
Severe Alcohol intoxication | Can be ILT | Rapid | Death | None | ED | EMed staff +/- Anaesthetic staff Acute Med | Paramedics Critical care EMed/med bed Pharmacy D&A team | ED Any medical/ ED bed | EMed staff | Paramedics Pharmacy |
Syncope cause | Emergency | Not predicted | Mild | None | GP surgery ED | GP EMed staff Acute med staff | Paramedics Physicians OPD START team | GP OP follow up unless ALTE | GP Physicians Physio OT | ECG machine |
Anaphylaxis | ILT | Rapid | Death | None | GP surgery Community ED Wards | Self GP Nurses Paramedics Physicians | Observation beds Pharmacy Allergy clinic Pathology | Community Observe in GP surgery Hospital at home | GP Nurses Paramedics Allergy clinics | Allergy clinics Pharmacy Ambulance service |
GI haemorrhage | Emergency | Rapid-mild | Death - moderate | None- 24hrs | Community OPD ED SAU | GP Ambulance service EMed staff Surgical staff | Operating theatres Pharmacy Endoscopy Blood transfusion service Pathology | OPD if relatively well ED if haemo-dynamically unwell | Surgical staff OPD staff EMed staff Ambulance service | Operating theatres Pharmacy Endoscopy Blood transfusion service Pathology |
Ruptured abdominal aneurysm | ILT | Rapid | Death | None - Unless previously diagnosed and decision not to treat made | ED SAU | Ambulance service EMed staff Vascular surgeons | Radiology Operating theatre staff Pathology Blood transfusion service Surgical wards | None unless decision made not to treat when care could be given in community | None unless decision made not to treat then community nurses, GP | As before |
Perforation and Peritonitis | Emergency | Rapid | Death | None | ED SAU | Ambulance service EMed staff Surgeons Surgical nurses | Radiology Operating department Pathology Blood transfusion Surgical wards | None unless decision made not to treat when care could be given in community | None unless decision made not to treat then community nurses, GP | As before |
Ophthalmologic | Emergency - semi-elective | Moderate - slow | Moderate - none | Variable - 6hrs-days | Community ED Eye clinic MIU | Opticians EMed staff GP Opht-halmology | Radiology Pharmacy Operating department Eye clinics | Treatment by opticians or eye department directly Direct access needs to be agreed | Pharmacy MIU Eye clinics Operating departments for some Eye wards | As before |
Oral and maxillofacial | Emergency- semi-elective | Moderate to slow | Moderate to mild | Up to 24hrs | Community ED Max fax clinic | Dentists EMed staff Max fax staff | Radiology Pharmacy Max fax clinic | More access to dental surgeries for Rx of emergencies Pharmacists - self Rx with antibiotics Max fax trauma to speciality MIU | Dentists Pharmacists | Radiology Procurement |
ENT | Emergency - semi-elective | Moderate to slow | Moderate to mild | None to 24hrs | Community ED ENT clinic | GP EMed staff ENT surgeons | Radiology Medical supplies OPD OD ENT wards | Direct access to ENT clinic for emergencies MIU | ENPs ENT staff | Radiology Procurement for equipment Medical supplies |
Review clinics | Elective | Not predicted | Mild - None, depending on condition | Days to weeks | ED | EMed physicians and nurses | OP clinics GP Plaster rooms Radiology | Varies according to condition Direct FU in specialist clinics e.g. orthopaedics Review in community | GPs Practice nurses Staff in OP clinics | GP Radiology OP |
Psychiatric Emergencies incl section 136 | Emergency | Not predicted | Usually moderate | Variable None to 24hrs | ED Acute Psychiatric assessment units Community | EMed Psychiatry Police Ambulance PSW GPs Crisis teams | Psychiatric Hospitals CDU/acute beds Families OPD Pharmacy Police | Psychiatric hospital or units Community | GP Crisis teams | Ambulance Police Families |
Stroke | Usually emergency ILT | Not predicted | Death - though variable | None, though decision could depend on pre-morbid state | GP Ambulance ED MAU | EMed Stroke team Physicians Neurologists Radiologists | Medical beds Stroke beds Radiology Physio OT Social services Families Pharmacy | To some extent depend on co-morbidity Either direct to - stroke ward or - treat at home | Community nurses Families GP | Social services Private care providers |
Acute severe/ ILT asthma | ILT | Rapid | Death | None | GP Community Ambulance ED MAU | EMed Acute physicians | Respiratory teams OPD Radiology Crit Care Medical beds Pharmacy | Community ED Some will need ITU | Paramedics GP surgery EMed staff | Medicine respiratory staff Radiology etc Critical care teams in community |
Sudden Headache SAH | ILT | Not predicted | Death - though variable | 0-12hrs | ED MAU | EMed Acute med | Ambulance GP Critical care Neurosurgery Radiology | Could consider community LP without CT when no CT Others would require CT/ LP | GPs Nurses EMed | As before |