Best practice approach to the launch and management of Urgent Treatment Centres
Urgent Treatment Centres have been established alongside many Emergency Departments in England, and national policy is encouraging wider adoption. They aim to divert work away from the emergency department to enable staff to focus on the management of the more seriously ill and injured. There is great variability in how these centres are staffed and managed.
As the former Professor of Emergency Medicine at Warwick Medical School and the National Clinical Director for Urgent and Emergency Care at the Dept of Health in England, Prof Matthew Cooke, shares his experience of working with many units that have an Urgent Treatment Centre co-located with their Emergency Department.
Prof Cooke, who is now the Chief Medical Officer for Xyla Elective Care, part of Acacium Group, shares his top tips based on clinical evidence and the value of his personal observations.
- Regarding patient selection, a combination of ‘push’ by the Emergency Department triage nurse and ‘pull’ by the Urgent Treatment Centre team will maximise numbers. There needs to be clear criteria of who goes to an Emergency Department, Same Day Emergency Care, and Urgent Treatment Centre. The criteria vary between departments but are often based on traditional boundaries and concepts rather than skillsets.
- Don’t have quotas. Some Urgent Treatment Centres only allow a certain number of patients per hour from Emergency Departments. Urgent Treatment Centres should see the patients suitable for them with the ability to flex capacity if busy, not to divert work to others.
- All ages should be seen in the Urgent Treatment Centre.
- Patients should have the ability to book GP appointments as an alternative to being seen in the Urgent Treatment Centre. They should be given a specific timed appointment at their own GP if they are suitable for next day care; they should not be told to go away and book an appointment themselves.
- The ability for the triage nurse to book people into timed slots in the Urgent Treatment Centre can help to cope with inevitable surges of activity.
- Skill sets are more important than professional backgrounds. A flexible workforce who can see not just minor injuries and illness but also other primary care conditions, such as mental health are highly valuable. It is important for Emergency Department staff to understand the skillsets of the Urgent Treatment Centre staff.
- Integrated IT systems should allow for single entry of information and the seamless transfer of information to primary or secondary care.
- Access to tests (blood and x-rays) allows more patients to be seen, but an audit of their usage may help prevent the Urgent Treatment Centre developing an Emergency Department mindset to tests.
- Direct referrals to specialty teams should be available from the Urgent Treatment Centre. Patients should go direct to their referral, with no need to go via the Emergency Department.
- The ability to book follow up treatment, when needed, in primary or secondary care will prevent return visits.
- Urgent Treatment Centres should have clear and easy routes to access community and social care services. This will allow for ’safety-net’ interventions for patients well enough to be seen in the Urgent Treatment Centre but otherwise at risk if not reviewed.
- Chronic disease management is not a function of an Urgent Treatment Centre, but many people present with exacerbations of long-term conditions. There should be an expectation of giving advice on self-management of their condition and the ability to refer them for advice and support for their long-term condition.
- GP registration for those not currently registered will help people get the appropriate management of long-term conditions and easier access for urgent care in the future.
- The variation of attendances by the hour of the day, day of the week and seasonally needs to be continuously monitored to enable appropriate levels of staff with appropriate skillsets.
- There needs to be clear governance for Urgent Treatment Centres. The absence of a fixed model should not be used as an excuse for delaying the formation of an Urgent Treatment Centre but needs careful consideration of whether this is a primary or secondary care service from the perspective of the insurers.
- Urgent Treatment Centres can be a unique training experience. Junior doctors need to have time in an Urgent Treatment Centre to gain experience in those conditions. This is especially valuable for those planning careers in primary care and emergency medicine. Paramedics can learn skills that enable them to choose different destinations or complete treatment at home. The system must allow training but should not be defined by it.
Urgent Treatment Centres often help relieve the pressure on the collocated Emergency Department but need clarity over staffing, management, and patient selection. In Prof Cooke’s experience, the least productive Urgent Treatment Centres suffered due to a lack of clarity or a competitive approach between providers.
The above insights were provided to support the application and roll out of Urgent Treatment Centres. If you are currently lobbying for or undertaking an Urgent Treatment Centre project, we’d love to hear your views. Please continue the conversation with Prof Cooke.