SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

Streaming, registration and initial assessment key features
must be inter-operable with both Trust and GP systems to ensure that:
o Patient details will not have to be taken again in the event of streaming/ transfer to
ED.
o Child/ vulnerable adult „Red Flags‟ can be picked up by UCC staff.
UCC patient streaming should be complete within 20 minutes (adults) or 15 minutes (paeds).
A suitably competent clinician will carry out the assessment of patients attending the centre 1 .
Clinicians with suitable competencies will include GPs, emergency nurses and other suitably
qualified clinicians to meet case-mix demands.
Single assessment process for all UCC/ED walk-in patients – patients requiring transfer to ED
should not need to be assessed again on arrival.
Some aspects of treatment and diagnostic investigation could and should be provided at the
streaming and assessment stage (e.g. analgesia, ordering of X-ray). Clinicians providing
initial assessment should possess the skill set necessary to provide this treatment.
In accordance with Healthcare for London guidance, the UCC is expected to make all „see
and treat‟ decisions within 60 minutes; that is to say, the UCC is expected to identify and pass
all appropriate patients through to ED within 60 minutes from the time of registration, so the 4-
hour target remains achievable for the ED.
Patients attending who do not have urgent care needs will be supported by the staff in the
centre to access advice and care from their local community pharmacist, or to make an
appointment with their own GP practice. Where appropriate, this will be achieved using the
„111‟ service.
Patients attending the UCC who are not registered with a GP will be treated by the UCC
according to the same criteria as a registered patient. In addition, they will be supported by
the staff in the centre to register with a local practice of their choice.
Patients may be referred to community based services, including general dental services,
pharmacy services, community nursing, and social and voluntary services. UCC reception
staff will have up-to-date details of all community and primary care based services and will be
able to provide patients with contact numbers/service details and opening times in order that
they are redirected to core primary care service provision.
Contingency plans should be put in place to deal with unexpected surges in demand in order
to ensure that waiting times are kept under control. These plans should minimise the volume
of clinically inappropriate transfers to ED.
7.14.4 Diagnostic scope
The UCC will have access to diagnostics and investigations run by the hospital Trust from
the hospital site. Only urgent diagnostic action will be initiated. It is therefore not anticipated
that the level of diagnostics provided will exceed that provided in a standard GP surgery,
other than the additional diagnostics that may be required for minor injuries (e.g. X-ray).
Requests for diagnostic testing will be audited on a regular basis.
UCC patients may require access to diagnostics where this would contribute to a decision
regarding the patient‟s immediate treatment or referral. It is therefore recommended that,
with the exception of tests requested as part of an onward referral to a specialist clinic, all
test results should be available within one hour.
The E&UC CIG recommends that the following investigations and diagnostics are available
to UCC clinicians:
Figure 7.37 Recommended diagnostics available at a UCC
Diagnostic area
Electrocardiogram (ECG)
Haematology
1 College of Emergency Medicine Triage Position Statement, April 2011.
Diagnostic tests available to UCC
Full blood count (FBC)
D-Dimer
7b. Work of the Emergency and Urgent Care CIG 158