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Urgent care standards

In order to deliver our critical success factors for urgent care we need a set of standards which describe how we expect the system to operate more effectively and a set of measures by which we can monitor the level of quality it is providing.

Leading clinicians and managers from across the East Midlands have collaborated and brought together these essential standards and quality requirements using national evidence. 

Our urgent care system has been broken down into discrete domains with:

  • A definition

  • Attributed best practice (both nationally and regionally)

  • Associated service standards and performance indicators. 

 

This structured approach enables health communities to review their care provision and standardise their approach. It provides assurance that services for urgent care are appropriately designed to deliver an integrated seamless service to meet the needs of the patient, whilst making the most appropriate use of resources in a timely and efficient manner, ultimately producing the best outcomes for patients.

The domains are:

System management
 Standard Key Performance Indicator
(SM/BP1) An Urgent Care Network is in place which as a minimum, meets Emergency Care Network Guidance (2007) and the Emergency Care Network Checklist (2004) (SM/KPI1)The Urgent Care Network meets the agreed minimum standard, as outlined in the Emergency Care Network Guidance and the Emergency Care Network Checklist 
(SM/BP2) Clear commissioning arrangements exist, based on evidence of effective and efficient delivery of urgent care to meet the East Midlands Urgent Care Service Standards (EMUCSS) (SM/KPI2) An explicit partnership arrangement and commissioning plan is implemented to meet the EMUCSS
(SM/BP3) A maintained Electronic Directory of Service (eDoS) which is easily accessible to clinicians is commissioned to support the implementation of NHS Pathways  (SM/KPI3) An electronic skills based Directory of Services (eDoS) is in place which meets the agreed scope of urgent care services and is staffed appropriately 
(SM/BP4) There is an agreed data set and governance framework in place, covering health and social care, to ensure that the urgent care system is planned, coordinated and managed appropriately  (SM/KPI4) An information governance plan, including data definitions, is agreed and in place 
(SM/BP5)The Urgent Care Network drives service improvement and reduces clinical variation across all health and social care providers, through effective performance management of key performance indicators  (SM/KPI5) Monitoring of levels of service variation across all providers in the East Midlands is in place, and variation is reduced to 5% 
Prevention (of unecessary hospital admissions)
 Standard  Key Performance Indicator
(PCC/BP3) As part of the implementation of NHS Pathways and eDoS access criteria for primary and community services is specified, to ensure the services support the delivery of urgent care 

(PCC/KPI3.1) Number of admissions for all ambulatory care sensitive preventable conditions;

(PCC/KPI3.2) Percentage of patients who are not Category A/B calls conveyed to the ED by ambulance, as a percentage of the total number of patients conveyed to the ED by ambulance 
(PCC/BP6) People with complex conditions within the community should be identified and supported with a multidisciplinary response, based around the GP practice, to ensure the development and implementation of personalised care plans focused on reducing the need for unwanted and clinically unnecessary hospital admissions   

(PCC/KPI5) Each GP practice has a clearly agreed protocol with their community health and social care partners covering case finding, personalised care planning, multidisciplinary assessments with geriatrician input and arrangements for monitoring the effectiveness of the protocol;

(PCC/KP15.1) Percentage of patients admitted due to breakdown of informal care or family, primary and community health or social care – as a percentage of total admissions 
(PCC/BP8) Every patient with a long term condition should have a personalised care plan that includes anticipatory care and access to appropriate medication and treatment. In order to prevent unnecessary hospital admissions the plan should include defined resources and pathways as alternatives 

(PCC/KPI8.1) Percentage of patients attending the ED from residential and nursing home care who have a ‘Right Care’ or equivalent clinical care plan in place;

(PCC/KPI8.2) Percentage of patients not taken to the ED that are non- category A/B calls, as a percentage of the total number of non-Cat A/B (999) calls;

(PCC/KPI8.3) Percentage of people with a long term condition who have a personalised care plan 
Presentation
 Standard  Key Performance Indicator
(PCC/BP1) All patients requesting urgent care receive immediate triage by telephone or face-to-face consultation, resulting in appropriate navigation to health, social or community services that best meet their identified needs, which is agreed with the service users and delivered in a specified timescale

(PCC/KPI1) Percentage of 111 telephone calls assessed using NHS Pathways that end in a referral to an Emergency Department (ED) expressed as a percentage of total number of calls received 
(PCC/BP2) Within GP contracted hours, every patient requesting urgent care is given clinical advice on the day they contact the in-hours primary care service. If the patient stipulates a given date for face-to-face consultation, this request is met and undertaken by primary care  (PCC/KPI2) 75% of patients requesting urgent care services within GP contracted hours should receive their clinical advice in full, on the day, they contact the in-hours primary care service 
(PCC/BP9) In-hours emergency referrals to hospital organised by Primary Care will be accompanied by a print out of the Primary Care summary record including medications and recent consultations 

(PCC/KPI8.1) Percentage of patients attending the ED from residential and nursing home care who have a ‘Right Care’ or equivalent clinical care plan in place;

(PCC/KPI8.2) Percentage of patients not taken to the ED that are non- category A/B calls, as a percentage of the total number of non-Cat A/B (999) calls;

(PCC/KPI8.3) Percentage of people with a long term condition who have a personalised care plan 
(ACF24/BP1) All acute assessment and admission areas implement written processes of triage and prioritisation of patients, that include physiological track and trigger mechanisms (e.g. early warning scores)  (ACF24/KPI1) Evidence of comprehensive implementation of the Royal College of Physicians Acute Task Force Guidance10 and use of the capacity planning model, as a minimum standard 
(ACF24/BP6) Senior clinical decision makers should have electronic access to primary care Summary Care Records for all patients, as soon as these become available  (ACF24/KPI6) % of senior clinical staff with access to primary care Summary Care Records 
Assessment
 Standard  Key Performance Indicator
(PCC/BP4) The GP Out-of-Hours service meets the quality standards set out in the National Quality Requirements in the delivery of Out-of-Hours Services(2006)3 and participate in the Primary Care Foundation Out-of-Hours Benchmarking (PCC/KPI4) % of patients attending the Out-of-Hours service who receive their clinical advice in full, within 20 minutes of their appointment time 
(PCC/BP7) Frail older people attending hospital with an acute crisis should be assessed by a multidisciplinary team including geriatricians, within the first 24 hours of admission  (PCC/KPI5) Each GP practice has a clearly agreed protocol with their community health and social care partners covering case finding, personalised care planning, multidisciplinary assessments with geriatrician input and arrangements for

monitoring the effectiveness of the protocol;

(PCC/KP15.1) Percentage of patients admitted due to breakdown of informal care or family, primary and community health or social care – as a percentage of total admissions 
(ACF4/BP1) All Emergency departments (ED) will ensure senior ‘shop floor’ clinical presence from 08:00 until midnight, seven days a week, 365 days per year  (ACF4/KPI1) Percentage of time between the hours of 08:00 until 00:00, within a year, where a senior “shop floor” clinicianis present within the ED 
(ACF4/BP2) All EDs to implement strategies to ensure all patients receive a treatment or discharge decision within 120 minutes 

(ACF4/KPI2.1) Consistent achievement of the revised NHS operational standard , 95% threshold for ‘a four-hour maximum wait in the ED from arrival to admission, transfer or discharge’

(ACF4/KPI2.2) Achieve formulation of clinical decision in less than 2 hours for 90% of patients 
(ACF24/BP2) All acute medical assessment and admission areas implement Royal College Guidance - Acute Medical Care: The Right Person, in the Right Setting – First Time 

(ACF24/KPI1) Evidence of comprehensive implementation of the Royal College of Physicians Acute Task Force Guidance10 and use of the capacity planning model, as a minimum standard;

(ACF24/KPI2) The percentage of patients with zero length of stay 
Treatment
 Standard Key Performance Indicator 
(ACF4/BP3) All acute trusts, working collaboratively with their health community, implement a health community system to ensure a maximum response time of 30 minutes to speciality referral  (ACF4/KPI3) Acute to speciality referral response time less than 30 minutes 
(ACF4/BP4) Once a decision to admit to a speciality has been taken, patients should be admitted to an appropriate bed within 30 minutes  (ACF4/KPI4) Time between decision to admit to patient admitted to an appropriate bed less than 30 minutes 
(ACF24/BP3) All acute assessment and admission areas should achieve a maximum time from arrival to a clinical management plan within 2 hours for 90% of patients 

(ACF24/KPI3) 90% of patients receive a clinical decision within 2 hours;

(ACF24/KPI4) 90% of patients receive a clinical management plan within 2 hours, approved by a senior clinical decision maker (defined as above) within 4 hours and for 100% of patients within 12 hours 
(ACF24/BP4) Senior clinical decision makers (qualified medical practitioners holding postgraduate diplomas in their training speciality) should review and approve all clinical management plans (90% within 4 hours of arrival and 100% within 12 hours of arrival)  (ACF24/KPI4) 90% of patients receive a clinical management plan within 2 hours, approved by a senior clinical decisionmaker (defined as above) within 4 hours and for 100% of patients within 12 hours 
(ACF24/BP5) Specialist opinions will be indicated by initial assessments and will be required on day one to ensure a clinical management plan and a discharge plan is provided for those patients 

(ACF24/KPI5.1) An expected date of discharge for all patients is indicated within 12 hours of presentation;

ACF24/KPI5.2) All patients requiring a specialist review will receive it within 12 hours of their initial assessment 
(ACF24/BP7) All providers will have implemented the best practice for fractured neck of femur (Blue Book 2007)  (ACF24/KPI7) 90% NOF patients on best practice tariff 
(ACLoS/BP2)  Minimise the number of patients who are ‘outliers’ to the speciality 

(ACLoS/KPI2.1) Achieve a bed occupancy rate of 85% in acute specialties;

(ACLoS/KPI2.1) % of emergency admissions patients who reside on more than 3 wards (including admission unit);

(ACLoS/KPI2.3) Reduce re-admission (to the same speciality service for the same problem) within 30 days by 25%.
Discharge
 Standard  Key Performance Indicator
(ACLoS/BP1) Discharge planning should follow the Department of Health prevention resource package for older people - ‘Ready to Go?’ (2010) (ACLoS/KPI1.1) Reduce the number of bed days for acute and rehabilitation beds by 25% 
(ACLoS/BP3) An appropriate Electronic Discharge Summary (EDS) should include a diagnosis, treatment received, discharge medication, any changes to treatment compared to when the patient was admitted and advise of future management, if needed 

(ACLoS/KPI1.2) % of patients who do not have an Expected Discharge Date (EDD);

(ACLoS/KPI1.3) Increase the percentage of patients who have an appropriately completed Electronic Discharge Summary (EDS) within a maximum of 24 hours, (following discharge - target 100%)

Ongoing Community Care
 Standard Key Performance Indicator 
(PCC/BP5) All health and social care communities have in place a consistent intermediate care service that is jointly commissioned with social care, meets Department of Health Guidance Intermediate Care (2009)5 and is available to everyone who needs it. An intermediate care service is defined as:

“A range of integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admission and premature admission to long-term residential care, supporting timely discharge from hospital and maximising independent living.”

  

(PCC/KPI5) Each GP practice has a clearly agreed protocol with their community health and social care partners covering case finding, personalised care planning, multidisciplinary assessments with geriatrician input and arrangements for monitoring the effectiveness of the protocol.

(PCC/KP15.1) Percentage of patients admitted due to breakdown of informal care or family, primary and community health or social care – as a percentage of total admissions 
(Rehab/BP1) All health and social care communities have in place an equitable and consistent intermediate care service that is jointly commissioned and meets Department of Health Guidance (2009). 5 This is defined as “a range of integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admission and premature admission to long-term residential care, support timely discharge from hospital and maximise independent living” 

(Rehab/KPI1.1) Ratio of re-admissions (within 30 days) compared to total discharges;

(Rehab/KPI1.2) Average length of stay for acute episodes requiring subsequent rehabilitation;

(Rehab/KPI1.3) Waiting time to access community health therapies essential for discharge e.g. physiotherapy, occupational therapy (target zero %)

(Rehab/BP2) A rehabilitation pathway and services promoting recovery are clearly defined within this system  (Rehab/KPI2.1) Proportion of people in intermediate care receiving a comprehensive rehabilitation assessment (100%)
(Rehab/BP3) People admitted to hospital should have access to appropriate residential or community rehabilitation, re-ablement and recovery services, to ensure discharge occurs as soon as an acute health service intervention is no longer required 

(KPI2.2) Percentage of patients maintained in the community setting for more than 3 months, following intermediate care and rehabilitation;

(Rehab/KPI3.1) Ratio of monies spent on adult social care for older people on residential and nursing home care versus community services;

(Rehab/KPI3.2) Percentage of adult social care spend for older persons being cared for in their own home;

(Rehab/KPI3.3) Occupied bed days of patients declared medically well or waiting for transfer 
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