Reforming Emergency Care - Essay Example

Reforming Emergency Care Reforming Emergency Care Introduction Emergency care is a critical service in the health care sector in providing immediate pre-hospital care to avert serious medical conditions. Emergency care always faces new challenges that need to be addressed by the government, the health care institutions and professionals. A thorough assessment of the state of emergency care is necessary to identify the reforms that should be implemented. While the reforms are aimed to improve quality care for all age groups, they will reduce the risk to children and older adults (National Audit Office 2004). Reform in Emergency Care The NHS has been at the forefront in providing emergency care. The Department of Health released in 2001 a report outlining its objectives for NHS to further deliver quality service in the emergency sector, which are: “a) Ending long waits in A&E departments and for admission to hospital via emergency departments; b) Improving ambulance responses to life threatening emergencies; c) Providing a wider range of services appropriate to patients’ needs; d) Ending widespread bed blocking in the NHS; and e) Minimising the number of cases where patients have their operation cancelled on the day of surgery” (Department of Health 2001). The areas of concern identified for reform involve the manpower, resources, procedure, and organisational structure. There is a dramatic increase in the number of emergency patients that require the services of limited personnel NHS. There was an increase of more than 2 million emergency patients for the past decade that over-stretched the capacity of the personnel. The solution to this problem is hiring of 600 nurses by the end of the first quarter of 2003 and 183 consultants in 2004 who will be deployed across the country according to the needs of NHS institutions (e.g. busiest period, number of patients). To meet the needs for deficient resources, a huge budget (in millions) has been allocated for purchases and services. Delays in patient (who no longer need hospital care) discharge affect emergency patients whose operation should be postponed due to lack of available bed. Thus, a portion of the budget will be used for social care so that patients who can receive care at home can be discharged. With targeted reduced bed occupancy of 82 percent, the emergency unit would be freed of patients and at the same time reduce the cancellation of planned operations. Competition for resources between emergency needs and routine elective needs would be eliminated by hiring 600 medical specialists for emergency patients. There would then be no competition for resources between emergency and elective needs. Addressing resources issue is the provision of diagnostic and necessary services during nighttime and weekends. Emergency care would require diagnostic services even at night while these services operate for only eight hours in contrast to the 24-hour emergency operation. Work extension, proper skills mix, seeking private sector services, adoption of new technologies and “near patient testing” would provide the solution to this need (Department of Health 2001, p. 4). Identified healthcare providers (e.g. medicine, surgery, etc.) would be integrated to work together to comprise the hospital-based emergency service. Institutional procedure should be streamlined to facilitate provision of emergency care. Patients with minor injuries and those with serious conditions should be attended separately. With a single queue, minor injury patients in the line are left unattended when new patients with serious injuries arrive and given priority treatment. Streamlining of institutional procedure would give the patient the appropriate care needed and not end up to the improper service. The Clinical Assessment System can do away with the repetitive inquiry of different staff for information. An established assessment procedure will produce similar evaluation throughout the process as well as advice. This will lessen the need for GP services and hospital referral. A similar standard of care should also be implemented throughout the NHS system. A nationally used standard would eliminate the occurrence of varying assessments by different institutions for the same problem of the patient. Waiting time for patients queuing for care should be uniform across the country. Relevant institutions and professionals can decide on the most appropriate standard of care based on best evidence. Synchronization of functions and coordination among the units within an institution would solve the extended waiting time at every level of care. An Emergency Care Lead nominated to coordinate the provision of emergency care will hasten implementation of the reform agenda. The Lead will manage every facet of the emergency care network within the organization. An investment of £10 million by the end of first quarter in 2003 successfully freed clinical time and used in coordination while clinical work retention is assured. The National Audit Office assessment contained in the 2004 report, “Improving Emergency Care in England,” revealed mark improvements in the A&E departments. Waiting time has greatly decreased but still, there are cases that older adults wait for more than four hours that pose more risks to them (National Audit Office 2004). A qualification model in hiring A&E staff is still not available, thus, increasing the number of qualified personnel remains a problem. Building structures, although currently found to be unsatisfactory to meet the requirements for care delivery cannot be easily modified or restructured. In accordance with the 2001 objective, there was an improvement on the “single point” access wherein NHS Direct was attached with the “local GP out-of-hours services” which will be applied throughout the country by the end of 2006 (National Audit Office 2004, p. 4). The commissioning of local services and “GP out-of-hours services” enabled merging of primary care with emergency care. Pre-determined models will govern the use of GP services to facilitate implementation. Services are also redesigned to meet patient needs. In congruence with this, ambulance service is granted the option to bring the patient to the A&E, other service providers or to take home after treatment. As practised in the past, emergency patients are brought directly to the A&E for care and treatment. The decrease in patient waiting time indicates an overall improvement in treatment time. Personal of Assessment As a paramedic student, I observed the need for reform in the emergency care caused by the number of patients that should be attended to. I would be finishing the course from a university in three years but have experienced working in the ambulance service under NHS during that period that gives me an overview of the emergency scenario. The Bradley report (Peter Bradley, National Ambulance Adviser) mentioned the changes taking place in the emergency care service such as the use of digital radio communication system, more patient treatment in the community that reduced A&E admissions, decreased response time to calls, further improvement in cardiac care, etc. (Department of Health 2005). The report further suggested that ambulance clinicians work in the community and conduct home visitations in behalf of general practitioners (GPs). In my personal view, the role of a paramedic in emergency care is forever changing. I have seen more diagnostic machines being used in the ambulance service such as the more sophisticated ECG machines. Paramedics are also taught new skills that include wound closure and providing treatment to patients without bringing them to the A&E. With the paramedic giving the needed treatment, the patients can be brought or left at home without referring them to the hospital. The better referral pathways allowed the paramedic to decide whether to have the patient recuperate at home after providing treatment, referring the patient to more skilled paramedics (such as the emergency care practitioner), referral to GPs or admission to specific clinics integrated into the reform agenda that relieves pressure from admission hospitals. The paramedic can treat minor injuries and illness without need for hospital admission. Another reform taking place that I observed during the decade is the alternative route to becoming a paramedic through universities besides the traditional path of entering the paramedic service to gain experience and further qualify to the next level after a period of time. The university path offers a training and skills acquisition within a definite period of time. Thus, the student can expect to become a licensed paramedic upon completion of the course curriculum and practicum. In the traditional route (through the IHCD), the aspiring applicant has the option to prolong the period and can decide whether he or she is ready to apply for the next higher position in the ambulance service. Conclusion The emergency care sector should undergo a lot of changes in order to be responsive to the needs of the people and society. Reforms entail huge budgetary allocations but the government has to spare the needed funds in order to make the envisioned changes a reality and effective. Some changes have already been implemented and are found to be successful. But total implementation will take years and even decades to effect due to some conditions (e.g. lack of qualified specialised medical professionals, erecting of new building structures that suit the reform agenda and needs). On the level of the paramedic, I am satisfied that we are given the opportunity to acquire new skills on new diagnostic technology and wound closure. It is also a welcome move that paramedics can work on the community level and can conduct home visitations to relieve GPs and hospital admissions. Whatever little duties the paramedic can accomplish will have a great impact upon holistic emergency care sector. I would like to see more changes being implemented for the paramedics in the future. Personally, I would be very much willing to acquire more skills and learn how to operate more diagnostic machines so that in my level, I can already provide the best treatment that can be given to the patient. The alternative university route to become a paramedic is a positive move on the part of the universities to produce more skilled paramedics. There is a deficiency of qualified paramedics and the traditional route cannot provide the needed quantity of paramedics to man the system. Thus, with both the IHCD and universities working together to train students, more paramedics can graduate in due time. The government should also implement schemes to attract more students to undertake paramedic training, whether in the traditional or university routes. Incentives or scholarships can be offered, a subsidised study or a pay later study scheme. Total quality care can be achieved when a sufficient number of paramedics are deployed at strategic areas in the emergency care system. References Department of Health. 2001 October. Reforming Emergency Care. Available from: . [Accessed 29 March 2010]. Department of Health, 2005 June 30. Taking Healthcare to the Patient: Transforming NHS Ambulance Services. Available from: . [Accessed 2 April 2010]. National Audit Office, 2004 October 13. Improving Emergency Care in England. Report by the Comptroller and Auditor General. HC 1075 Session 2003-2004. Available from: . [Accessed 30 March 2010]. Read More