Emergency and Urgent Care
System Programme
The emergency and urgent care system is the focus of a five year research programme. Most health services research focuses on a service, but patients experiencing an episode of ill-health may not attend or consult a single provider. Instead they may make several contacts often with different services, interacting with different clinicians and support staff. This is particularly true of patients contacting emergency and urgent care services, and therefore we have added a system perspective to our previous research profile on individual emergency and urgent care services. Our programme consists of exploring the use of networks to manage the system, developing population indicators for measuring the performance of the system, and developing survey methodology for measuring the patient perspective of the system.
Recent progress on our programme includes:
1. Identified 16 performance indicators for the system
Given the range of services and pathways in emergency and urgent care, there is a need to develop a generic set of `system-wide´ performance indicators. We used a Delphi-style study of stakeholders in the emergency and urgent care system to identify a set of 16 key indicators based on outcomes and processes of care. An example of a process based indicator in our set of indicators is `Hospital emergency admission rates for acute exacerbations of urgent conditions that could be managed out of hospital or in other settings without admission to an inpatient bed". All 16 indicators are summarised in a PDF, which can be found as a PDF download in the 'Downloads' box.
2. Developed methods for the evaluation of the system from the patient perspective
We developed and tested a questionnaire and survey methodology for routine measurement of the system performance from the patient perspective. Our telephone population survey can identify system users in the previous three months. For users we can identify the length of their pathway, reasons for moving along a pathway, and user views of access, movement through the system and patient convenience of the system. We also developed a Toolkit to enable PCTs to undertake their own surveys, which can be found as a PDF download in the 'Downloads' box.
3. Initiated a study of the system performance in 4 PCTs
We are working closely with four PCTs which are making large changes to their emergency and urgent care systems in early 2009. We are testing the feasibility of calculating the performance indicators using national routine datasets and PCT data, and the responsiveness of the indicators to monitor change over time. We are undertaking telephone surveys of system users before and after changes to each system, and in early 2010 will conduct stakeholder interviews within each PCT to identify perceptions of changes to the systems. Each PCT will be viewed as a case study of different models of change.
4. Disseminated our work through the Healthcare Commission
In October and November 2008 we attended three conferences held jointly by the Department of Health and the Healthcare Commission to disseminate our indicators and Toolkit to PCTs in England.