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Management of Emergency Services at the UK’s top performing trust

The Luton and Dunstable University Hospital’s A&E is renowned for its top performing Emergency Department, with over 95% of patients who attend being treated or admitted in less than four hours. Managing the flow of over 10,000 patients passing through the Emergency Department’s doors every month is supported by the hospital’s Ambulatory Care Centre (ACC).

Introduced in 2013, the ACC plays a vital role in supporting the hospital by managing emergency patients without the need of an overnight stay – an alternative to the traditional practice. In ACC, appropriate patients can be seen by a member of the team within 20 minutes, by a consultant within 30 minutes and are then diagnosed and treated on the same day, before being sent home with on-going clinical support and supervision as needed. The service is not only cost-effective but also reduces the risk of hospital acquired infections.

Managing the flow of patients is carefully planned. Those referred to ACC through their GPs continue to receive prompt specialist care aligned to their needs, providing an alternative to acute hospital admission. This improves safety and patient experience, while freeing up vital hospital beds for those that urgently need them.

In 2013 ACC managed only 5-10 patients using a few clinical pathways, 9am to 5pm weekdays from the rear of the hospital. The relocation of ACC to the front door of the hospital in 2015 enabled medical patients to be directed straight from A&E. This was combined with GP referral patients, through a process driven model which resulted in 50-60 patients being seen each day, and a 35-40% reduction in medical admissions, which is above the national target of 30%.

Consultant Physician, Auditi Naziat who worked on the implantation of ACC says: “We continue to strive towards improving our provision of emergency care and recognise that when someone attends the hospital as an emergency it can be a very stressful time. Ambulatory Care enables us to move patients from two or three night hospital stays to zero, without affecting the quality or safety of their care.

“The facility allows us to see patients very quickly and if they require a higher level of care we have the ability to admit them to a ward directly. By avoiding unnecessary hospital admission we also reduce the risk of hospital acquired infections and free up space for patients with life-threatening illness.”

The Ambulatory Care service is available Monday to Friday, 9am to 9pm and weekends 9am to 5pm. Patients can be referred directly by their GPs. If patients require further care towards the end of the afternoon, home visits are arranged by the L&D’s Hospital at Home team, or alternatively follow up appointments are made for further consultation or treatment.