Urgent and emergency care

Prevention of as much ill health as possible is key. People with chronic respiratory disease must have planned reviews for treatment optimisation and exacerbation plans before winter. Flu and COVID-19 vaccinations are essential for these and other patients with long term conditions, so all clinical teams must enable their delivery. Appropriate specialist follow up after admission in these and many conditions can prevent readmission.

We recommend early screening for frailty of admissions for people over 65 with Clinical Frailty Scale and 4AT (for delirium). This identifies people who need rapid frailty assessment by specialist multi-professional teams. Front door frailty care must be a priority for these clinicians.

The staffing of acute admission units and SDEC units should enable people to be treated without admission where possible. Patients requiring short lengths of stay (48-72 hours) should receive optimal care. Patients requiring longer hospital stays must be cared for by the appropriate multidisciplinary clinical teams. Current ‘temporary beds’ or ‘outliers’ should be converted into multidisciplinary medical wards.

A greater focus on coordinating discharge is vital. This is already being done well in around a third of hospitals and must be replicated across the system. It requires close collaboration between ward teams and care coordination teams. Discharge to Assess, and early supported discharge - particularly for patients with COPD and heart failure - must be maximised. Hospital at home teams should be focused on these pathways.