Ambulatory Emergency Care

Clinical Lead: Dr Ash Sadighi

 Team
• Admin
• Nursing
• Doctors
• Microbiologist
• HCA
• Pharmacist
• Porters
• Specialty input
 AEC Aims and Objectives

• Assisting community services at the primary/secondary

care interface

• Providing emergency medical services within 24 hours

without the need for inpatient stay

• Support to specialist medical teams and A&E

• Facilitating in-patient discharges

 Operational Information
• Open 8am – 8pm Mon to Fri
• Weekend 11am – 2pm (nurse led)
• Last patient accepted 5pm
• Telephone manned by Consultant / SpR
• Open for advice and discussion of referrals
• Fax referral or SystmOne
• Patient information available (template on SystmOne
and intranet)
• GP e consult and GP portal queries all answered by AEC
Consultant of the week
AEC referrals: 1 few months
st

• Urgent care centre

• Accident & Emergency

• Wards

• OPD
 AEC referrals: Previous 12 months
Total Referral Sales
300

250
NHS
200 Hounslow
CCG
NHS
150 Total Re- Richmond
ferral CCG
NHS Ealing
100 CCG
Other
50

0
5

15

16
15
-1

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ay

No
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Discharge destinations
100%
90%
80%
70%
60%
50%
Home
40% Acute Ward
30%
20%
10%
0%
16
16

6
-1
b-
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ar
Ja

Fe

M
 Examples of Some Common Cases

• Cellulitis • Rashes
• DVT • Pneumothorax
• PE (low risk) • Pneumonia
• Anaemia and • Pyelonephritis
transfusion • Fever in returning
• Osteomyelitis traveller
• Deranged LFTs • Headache
• Temporal Arteritis • AF
• Pleural effusion • Ascites needing
drainage
 “Hot Clinics”
• Hot Clinics – 1 stop clinics. Seen by Consultant
or Registrar in Speciality. Usually 4-6 slots a
week.
• Endocrinology Hot Clinic – Tuesday pm
• Gastroenterology Hot Clinic – Tuesday am
• Rheumatology Hot Clinic – Thursday am
• Future plans – Care of Elderly, Thrombosis,
Neurology Hot Clinics
Work in progress
• AF pathway – now
operational

• OPAT (ICE referral)

• TA Pathway – now
operational

• Rapid Access Clinic for the

Elderly (RACE)/Neuro Hot
Clinic/Thrombosis Hot Clinic

• Heart Failure Pathway

 Nurse Led Services

• Iron Infusion • Infliximab Infusion

• Blood Transfusion • Tocilizumab Infusion
• Hyperemesis • Rituximab
• Short Synacthen test • Venesection
• Dynamic Tests • IVIG
• Glucose Tolerance Test • INR
 Examples of Procedures

• Pleural effusions
• Ascitic drains
• Chest drains
• Lumbar puncture
• Midline insertion
 Future Plans
• AEC Expansion
• New facilities including procedure room
• Ultrasound guided procedures – now operational
• Long line insertions – now operational
• Pleurx drains
• Initiation of AEC shifts into F2 rotas – from August
2017
• Continue development of other specialty pathways
 What the CQC thought…
• CQC feedback-“the AEC is effective in reducing the
number of inpatients and managing the increasing
number of patients who require emergency
admission following referral from a range of sources,
which include direct referrals from GPs.

• “The new AEC has made an impact on both A&E

performance and on reducing the number of
admissions. More importantly, patients we spoke to
were very positive about the care they received”.
What Patients Say
What Patients Say
 Patient Journey

• Fax referrals collected first thing in the morning for

vetting by AEC team
• Patients will be added to the list and contacted
before 10 am
• On arrival, bloods will be sent and then Doctor’s r/v
• Every case will be discussed with AEC Consultant
• All decisions Consultant led – Consultant presence
8am-5pm Monday to Friday
• Patient discharged to GP, come back for F/U or
referred to other specialties