the surrey emergency care system: a countywide initiative for change - touch screen button

Modernization is the core of government policy.
Within the NHS, it focuses to varying degrees on accidents and emergencies, coronary heart disease, clinical governance, and information technology, although each department tends to operate in isolation.
The Surrey emergency care system is a project that combines these parts into a single national initiative, laying a technical and clinical foundation for future integrated unplanned care networks.
This paper describes the project and its potential impact, and provides some insight into the barriers to change that the project has encountered so far.
The current mode of care traditional ambulance response to 999 calls has become more and more complex over time, but its basic elements have not changed for 50 years, and it has some structural defects: success is measured by achieving human time goals.
It is not suitable for clinical needs.
It is not necessary to transfer to the hospital.
Multiple paper and electronic records are generated for each call.
The responding staff had little access to the patient's medical history.
The "seam" between pre-hospital and in-hospital care results in: little coordination between repeated efforts and the resulting waste of time.
Bad "whole system" audit results-based change Research pressure there is change pressure within the NHS, including the potential drive towards more local and primary health care services and the drive to improve the quality of care and the quality of services provided to patients.
1 the government uses a combination of goals and additional funding to encourage change, but often focuses it on individual organizational levels.
It now seems that a more comprehensive approach may be more effective.
Health care is a vertical process provided by people of different levels
From patients at the grassroots level to consultant nurses and doctors at the highest level.
However, the organization of the NHS is horizontal and each layer has its own management and IT infrastructure.
Therefore, there is a conflict between the need to provide integrated clinical and social care across layers and the internal management structure.
This is exacerbated by the lingering culture of competition from the internal market.
It may be very different.
One example is the clinical need to provide rapid thrombolysis for patients with myocardial infarction.
This demand promotes innovation, highlighting the benefits of adopting a "system-wide approach.
For example, the transmission of ECGs from an ambulance before the patient arrives can be advanced
Warn the hospital team so that their response time is greatly shortened, 2 or ambulance staff provide remote support for pre-hospital thrombolysis, 3 or transfer the patient directly to a professional center for primary vascular prototyping (
Personal communication).
Then the patient should get the right care at the right place at the right time.
The clinical network is being developed and clinical infrastructure is being provided within the NHS to achieve a "whole system" change that has proven to be very effective in disease management.
For example, home monitoring in patients with heart failure (CHF)can pre-
Prevent acute aggravation and reduce the rate of inpatient visits by 50%.
The 4 community heart groups provide better, more coordinated care and are able to discharge early, reducing the average length of hospital stay for those admitted from 11 days to 6 days.
A model similar to 4A has been shown for falls and chronic pulmonary disease.
5 people accept that 40% 6-60% 7 "emergency" transfer hospitals can be better managed at home, and some pilot projects show that nursing care can be developed, including more advanced patient assessments, clearer home treatments, and other responses such as transfer to an intermediate care bed, transfer to a social service, or make an appointment directly with GPs
Combining these initiatives will fundamentally change the way services are delivered and minimize unnecessary accidents and emergency transfers (A&E)
/Free hospital beds for people who really need it.
Together, they represent a powerful clinical and economic driver of a more advanced out-of-hospital comprehensive care model.
Vision the Ministry of Health has a clear vision for the future of integrated first aid services in which patients can get a high-quality and consistent response to their needs 24 hours a day, here, patients who may need to be cared for in the hospital have a stream.
About 999 calls require urgent care and transfer to the hospital, while the rest of the calls may be better transferred later to the hospital or fully managed in the community.
In Surrey, many members of the entire health economy, social services, patients and the public have incorporated this vision into the SECS program, which has six different elements: seamless specialist electronic medical records (SpEPR)
Attached: electronic patient report for ambulance (e-PRF)
Electronic Medical Record Integrated audit tool integrated computer decision support system (CDSS)
Patient record telemetry for specific issues and facilityA community response for 12 major ECGsVirtual case sessions (
(Including falls, Swiss francs and chronic lung disease)
County emergency capacity management system (ECMS)—
A network-based system can be accessed by the entire health economy and can monitor the overall capabilities of the entire health economy in real time.
Load of A & E department, light injury unit (MIUs)
Walking in the center (WICs).
The available capacity of each hospital and the capacity of direct ambulance staff for accommodation and care homes, by providing information on the availability of beds and equipment, maintaining a "risk register" for their patients to support the intensive care network for vulnerable patients and their community caregivers the future model of nursing first aid cases will be attended by an ambulance worker, they have access to their EPR summary and transmit it to the bearer e-commercePRF.
The staff will evaluate and manage patients using voice recognition software and touch screen computers and enter their findings.
The CDSS will advise and prompt care, the caregiver will register through the touch screen, and the computer will automatically code and date and timestamp.
ECGs and physiological data will be automatically merged into e-
Then transfer to the most appropriate PRF (
Not necessarily recent.
The front end of A & e epr consists of the emergency department.
Interventions will be added and transmitted as needed.
Upon arrival, the patient will be taken
The identified bed, whose location will be decided and informed of the ambulance staff before the ambulance arrives, where the care will be handed over to the waiting team.
In due course, the patient's course in the hospital and a summary of the patient's clinical outcomes will be transmitted back to the ambulance service to complete the recording and conduct a meaningful audit.
Emergency cases will receive the same initial response, but in some cases attending clinicians supported by CDSS will decide that patients will not need to be transferred to the hospital immediately.
For them, the ambulance personnel will hold one or more "virtual case meetings "(
Originally a simple call, but it can be a conference call or a video conference in time)
With NHS Direct, GP, community care team, expert Response Team (
Waterfall, for example)
Or social workers, in many cases, give care to them.
For those who need emergency rather than emergency access, the system will ensure that the necessary support is provided and that advice is provided by the emergency capacity management system (ECMS)
, Will arrange direct transfer to designated beds that may exist in the community in a timely manner. Non-
Emergency (now)
Ambulance staff and subsequent patients are classified as unusual cases
In case of emergency, they will manage them on site at the appropriate time, contact the NHS directly for further advice and support, or book their GP, local MIU will see them, or WIC within the appropriate time frame.
The potential impact of SECS is far-reaching.
It provides a clinical and technical network to support a fundamental shift from hospital-focused first aid care to a more refined, community-focused model.
Improve the quality of social and clinical care, reduce hospital transfer by 40%-60%, and reduce hospital pressure.
It also has the potential to reduce the average working cycle time of ambulances, thereby increasing the response time to real life-threatening cases.
SECS is a catalyst for some primary health care trust funds (PCTs)
Developing community teams of falls, chronic lung obstruction and heart failure, aiming to reduce bed occupancy by 50% and relieve stress in the acute attack department, thus increasing throughput of "cold" surgical cases, to reduce the waiting time for surgery.
Direct reception of emergencies will reduce the pressure of trolley waiting in A & E
The emergency care network will improve the quality of care, encourage integration and reduce duplication of work inherent to the current system.
CDSS based on an indispensable evidence-based guide to e-commerce
PRF and EPR will support social and clinical care regardless of location, which will take into account the patient's condition and clinical condition and follow a consistent path of integrated care.
Common audit tools and processes further consolidate the integrated approach to care and enable the results audit of the entire system when the button is pressed.
All of these concepts have been proven somewhere, and the technical solutions that deliver these concepts have also been well developed.
What is unique about SECS is that they are brought together in a community that turns out to be a challenge.
The SECS, which has been planned for four years and supported by all of Surrey's acute trust and PCT CEOs and A & E directors, are well suited to the NHS modernization agenda, and was actively supported by many key roles in the NHS, including two ministers, the strategic health bureau and the Department of Health and Social Affairs, nursing-
However, it is still not implemented.
The obstacles to change are beneficial.
From a clinical and economic point of view, it may be beneficial for real money and resource transfer and financial stability to shift the focus from acute to community care, but there is no general model to prove this.
The Swiss franc and the community model of chronic lung obstruction may reduce the number of acute bedridden days in Surrey by 12 000 days per year, thus enabling the hospital to close the ward or manage the surgical load more effectively.
However, unless the ward is closed, less medical bed days will only save marginal costs, while more surgical costs will increase, and the new community team will need "real" new funding.
The difficulties are obvious.
Marginal savings and better performance in the acute sector compared to more costs in the community.
Better quality of care and service compared to possible increased costs.
Where is the balance of the new NHS, and how and where to re-
Is the allocation of resources.
Technology this technology is relatively easy to develop, and although the security and secrecy of the "center" has been fully addressed from the beginning, this concern has been a recurring theme.
As government policy shifts to this model, initial concerns about shared access trust networks have decreased over time.
The important technical barrier is that some local IT professionals are nervous about the change rather than the technology itself.
In addition, it is clear that the senior level is not willing to consider new methods such as virtual case meetings.
Joint Planning is building many emergency care networks around A single A & E unit, but what is really needed is real collaboration with all parts of the community that share the agenda.
The SECS programme requires significant joint work and change in seven acute trust funds, five PCTS, one StHA, one health and social care sector, ambulance services and communities.
It is committed to the clinical modernization of A & E, ambulance services, intermediate and community care, and coronary heart disease, each with its own overall processes and infrastructure.
IT modernization is out of touch with all this.
Therefore, there is no established mechanism to jointly plan the procurement and implementation of projects throughout the community.
Debate and agree that clinical changes are necessary that link clinical management with IT modernization, so much of the planning effort falls on a trust that leads to a relative lack of ownership.
It is essential that the diversity of secs creates a situation where almost all involved see the benefits and actively support the project, but no one has the right to say yes ".
Clinically, SECS encourage consistency, which is critical in providing consistent care, regardless of geographical location, but on the other hand is a curse for most clinicians.
It is difficult to determine the appropriate level of coordination and what/who needs to be changed.
Again, there is no mechanism for sharing funds across the community, and in fact, individual wallet holders tend to say "we will support but they should pay ".
When the cost is in one organization and the benefit is in another, the "Five case model" of IT procurement becomes very complicated.
It is more complicated to think that it is technical, quantifiable and pre-existing, and that the benefits are clinical, qualitative and potential.
Joint Planning is a problem for Surrey, and it will be a bigger problem for the larger community.
Balance of mobile power11 (StBOP)
StBOP transfers electricity from the hospital to the community and should address some of these issues in a timely manner.
PCTs will effectively control the NHS budget locally and run the service on a community-wide basis.
They should therefore be able to encourage and implement change.
Similarly, the New Strategic Health Authority (StHA)
A mechanism will be provided for joint planning and signing, and concentration under the leadership of the CIO will help to coordinate.
These factors have not been in place until recently, and it may take some time before PCTs and StHA can be fully established and feel innovative.
Projects of such a size as the "procurement rules" must, of course, adopt the Official Gazette of the European Community (OJEC)
And comply with the nhs it procurement rules.
Due to its broad potential, each part of the strategic outline case and outline business case appears to have been reviewed by the Ministry of Health and almost every part of its relevant agencies before all others comment, they are willing or able to move on.
As a result, this process is very time-consuming and expensive, so new initiatives have emerged (and gone)
This has a direct impact on the SECS, so the SECS have been working on moving sand constantly.
Personnel changes within government departments have also led to continuous transcendence of the old areas.
The documentation to support the programme is very long.
As a result, it is often broken down by evaluators into professional areas and distributed for comments.
Therefore, the individual considering the case is often not a party to the overall "big picture.
When they ask questions that are answered in other parts of the business case, a lot of time is wasted.
At other times the process met some people who seemed to feel that it would never work and would not work on their patch.
Others claim that despite the large number of clear statements made by StHA, DHSC and local partners, there is no local support.
The Surrey Health community supports it and is willing to give it a try.
Despite these problems, the programme is still on the agenda, indicating that it is supported locally, that it is appropriate and that it is flexible enough, able to respond to the changes brought about by national and local initiatives.
Conclusion secs is only one of the models of a community integrated first aid system ready for implementation.
With the establishment of the new NHS structure and the maturity of the new clinical program, SECS will become a reality and bring about substantial changes.
We believe that all the components are in place, but the "purchasing system" has always been a considerable obstacle.
The Surrey Ambulance Service is a "three star" organization that can be accessed on its own.
However, this is inconsistent with the system-wide approach to the programme.
It must therefore wait for a final agreement to be reached by the person executing the programme.
There are too many obstacles and red tape on the road to modernization.
If SECS are to be a model of reality and change, in fact, if the government really thinks that any combined integrated care is the way forward, they have to make it easier.
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