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

UCCs will need to maintain high standards of initial assessment and manage waiting times
especially pro-actively.
Recommendations
1. Initial assessment should be conducted by a suitably competent clinician to ensure that serious
cases are identified and transferred to ED early.
7.15.3 Access to diagnostics and investigations
In the opinion of the E&UC, non co-located UCCs should provide the same range of
diagnostic tests as their co-located counterparts. With the partial exception of X-ray, target
times for diagnostic tests and standards covering the ability of UCC staff to interpret results
will continue to apply.
The E&UC recommends that non co-located UCCs should have 24/7 access to X-ray
equipment and the radiographers needed to operate it. The UCC is required to develop a
process through which X-rays can be subject to a medical interpretation, as part of the
episode of care.
Where X-ray is not available on-site (for example, during periods of low activity), patients
should be transferred to an alternate site within 90 minutes if necessary.
Whereas co-located UCCs will be able to make use of pathology facilities available on „Major
Acute‟ hospital sites, 24/7 „hot‟ phlebotomy labs are unlikely to be available at „Local‟
hospitals. Non co-located UCCs must therefore be able to run, process and interpret
diagnostic tests „in house‟.
Recommendations
1. Co-located and non co-located UCCs should provide the same range of diagnostics and
investigations to the same set of standards.
2. UCCs should have 24/7 access to X-ray. Where this is not available on-site, patient care should
be transferred to an alternate site within 90 minutes if necessary
3. UCCs must make provision for running, processing and interpreting diagnostic tests without
support from the type of pathology facilities usually available at „Major Acute‟ hospital sites.
7.15.4 Patient transfer to ED/ specialist acute units (e.g. cardiac)
Non-emergency transfers
A proportion of non co-located UCC patients will need to continue their care pathway at an
ED (or other specialist acute unit). The vast majority of this cohort will be stable patients 10 ,
for example:
Patients who require testing or care that is out of scope for the UCC (e.g. urgent CT
scans, arterial blood gas)
Instances where the UCC clinician is unable to decide on an appropriate diagnosis
or treatment.
In the opinion of the E&UC CIG, the majority of these patients will not require „blue light‟
ambulance transfer. In many instances, these patients will possess their own means of
transport. The E&UC CIG therefore recommends that stable, non-emergency patients
10 „Building the evidence base in pre-hospital urgent and emergency care. A review of the research evidence and
priorities for future research‟ – Janette Turner; University of Sheffield, 2011
7b. Work of the Emergency and Urgent Care CIG 170