Article | Emergency department demand scheduling

This article is part of a series written by Optum Clinical Director and Consultant Emergency Physician, Dr Haidar Samiei. Read the previous article in the series here.

Most patients' first interaction with the emergency department (ED) is with the reception and the waiting room, where managing patients quickly and efficiently is important. Our partner eConsult identifies patient needs, directing them to the right clinician at the right time. Using iPads that capture triage history and emergency care dataset (ECDS) information, link to the NHS spine and automatically rank patients by clinical acuity, patients are checked in and triaged automatically within five minutes of arrival.

All this data flows straight into Symphony, enabling EDs to have clinical visibility of the waiting room within minutes. This saves the patient having to repeat their story, and most importantly of all, offers a better quality of care to our patients, freeing up scarce clinical resources from data entry. It allows appropriate patients to be prioritised and those suitable for redirection to be highlighted early, taking pressure off the front door of the department.

Symphony’s new functionality complements this by allowing you to create bespoke departments within the system for patients to be streamed into. These bespoke departments have personalised workflows which patients progress through, focusing on the key requirements for that area in minutes and seconds - rather than the hours and days that some hospital areas are used to dealing in.

Emergency department ways of working

I am noticing more and more trusts moving same day emergency care (SDEC) like areas into to the ED footprint, rather than moving ED ways of working to SDEC areas. We need to find ways of enabling all SDEC like areas, whether affiliated with or removed from the ED to work like ED’s, rather than make everything that needs to happen at pace belong to the ED.

Symphony enables us to move ED ways of working to different areas instead of mandating that anything requiring 0-day length of stay move to the ED. We can empower SDEC by allowing quick streaming and sharing of information (clock times, clinical information, tracking grid information etc) between departments without impacting the bespoke workflows in departments. We can - at times when SDEC is not available or when overwhelmed - use Symphony clinics or scheduled appointments to bring patients back in.

However, we choose to implement SDEC, it is important we commit to do so wholeheartedly. As we know from model hospital data 80% of patients seen in SDEC have a 0-day length of stay, whilst patients managed through wards have an average 4.2 day length of stay.

I think this way of thinking will grow, and to capture it we will be implementing the fourth iteration of the ECDS. This introduces the concept of an overarching urgent care episode, encompassing both initial consultations and reviews to create a consistent picture across Urgent and Emergency Care. Using ECDS 4 alongside multiple departments, schedules and clinics enables you to better link and track both individual patient care journeys, but also report on how the system as a whole manages certain presenting complaints, investigations or number of contact points required.

Read the next article in the series where Haidar explores managing patients: seeing all the data.