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Rapid Review of Hospital Element of Unscheduled Care Services in North Wales

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Rapid Review of Hospital Element of Unscheduled Care Services in North Wales National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales: Profile of current unscheduled care services in North Wales Authors: Siobhan Jones and Claire Jones Quality Assurance: Dr Rob Atenstaedt, Consultant in Public Health Medicine, NPHS (Local Public Health Director, Conwy & Denbighshire Local Health Boards) Date: 10/6/09 Version: 2 Status: Final Intended Audience: Expert and Stakeholder Groups in Feedback Session on 24th June 2009 Purpose and Summary of Document: This report forms part of a series of documents comprising elements of a rapid review of the hospital element of unscheduled care services performed by the National Public Health Service for Wales on behalf of the Unscheduled Care Services Project Team Publication/Distribution: • Clinical Strategy Website Author: Siobhan Jones/Claire Jones Date: 10/6/09 Status: Final Version: 2 Page 1 of 18 Intended Audience: Expert & Stakeholder Groups National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales Profile of current unscheduled care services in North Wales Description of Current Services 1. Number and type of A&E Departments in North Wales Table 1 and Map 1 detail the number and location of unscheduled care services in North Wales. North Wales residents also access unscheduled care services outside North Wales at Countess of Chester, Bronglais and Royal Shrewsbury Hospitals. Table 1.Number of A&E, Minor Injuries Units and Out-of-Hours GP Units in North Wales, 2009 Number Hospitals with A&E Department 3 Hospitals with Minor Injury Units 15 Hospitals with GP Out of Hours Unit 10 2. Location of A&E Department in North Wales Map 1. Location of North Wales A&E, Minor Injuries Units and Out-of-Hours GP Units* Author: Siobhan Jones/Claire Jones Date: 10/6/09 Status: Final Version: 2 Page 2 of 18 Intended Audience: Expert & Stakeholder Groups National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales * MIU services and GP out of hours services at Bron y Garth Hospital moved to Ysbyty Allt Wen in Penmorfa in March 2009 3. Minor Injuries Units There are 15 Minor Injuries Units across North Wales. These are described in Table 2: Table 2. MIU’s across North Wales Community Hospital Colwyn Bay Llandudno Denbigh Ruthin Llangollen Mold Flint Holywell Chirk YsbytyAllt Wen Bryn Beryl Tywyn Memorial Dolgellau Ysbyty Penrhos Stanley In Denbighshire, a minor injuries enhanced service is provided by primary care in the areas without Trust provision, primarily Rhyl and Prestatyn in the north and Corwen in the South (ref: Wales Audit Office (2009) Unscheduled Care: unplanned, urgent or emergency health and social care. Survey of Local Health Board Chief Executives (Denbighshire)). Conwy – a minor injuries enhanced services is provided by primary care in the more rural areas, to provide a local service to this population (Betws y Coed, Llanrwst and Cerrigydrudion) (ref: Wales Audit Office (2009) Unscheduled Care: unplanned, urgent or emergency health and social care. Survey of Local Health Board Chief Executives). There is a GP out of hours centre in Penrhos Stanley on Saturdays and some bank holidays Author: Siobhan Jones/Claire Jones Date: 10/6/09 Status: Final Version: 2 Page 3 of 18 Intended Audience: Expert & Stakeholder Groups National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales 4. A&E Facilities During March/April 2009 a service profile template was sent out, and completed by, senior staff from the Emergency Departments and/or Medical Directorate at Ysbyty Gwynedd (YG), Ysbyty Glan Clwyd (YGC) and Wrexham Maelor (WM) Hospitals (see Appendix 1). The template provides an overview of the current service provision at the three main A&E departments in North Wales. This section of the report provides a summary of the information provided. 4.1 Size of A&E Departments The A&E department at Ysbyty Gwynedd (YG) has 3 cubicles, 4 treatment rooms, 6 assessment bays and 4 resuscitation bays. Ysbyty Glan Clwyd (YGC) A&E department has 12 cubicles, 4 adult treatment rooms, 1 paediatric treatment room, 1 room for the assessment of mental health patients and 4 resuscitation bays. Wrexham Maelor (WM) A&E department has 8 cubicles for the treatment of minor illness and accidents, 9 cubicles for the treatment of major illness and accidents and 4 resuscitation bays. 4.2 A&E backup facilities All of the three A&E departments have access to the facilities of an Acute Medical Assessment Unit (AMU/MAU) An AMU is a dedicated area for managing acutely ill medical patients who are being admitted. Ysbyty Glan Clwyd has a 30 bedded AMU and WM has 23 bedded AMU. None of the 3 A&E departments currently have a Clinical Decision Unit (CDU) for patients who require a period of specific investigation and active clinical management to allow early and safe discharge, although WM report that there are plans to set up a CDU next year. WM also has a Surgical Assessment Unit. All three hospitals have Intensive Care Unit facilities. YG currently has 3 Level 2 Critical Care beds and 7 Level 3 Critical Care beds. Wrexham Maelor hospital has 12 Level 2 critical care beds and 5 Level 3 critical care beds. YGC currently has 8 level 3 critical care beds and reports that an expansion of critical care in the hospital is planned. YGC also 1 overnight intensive recovery bed (operated if staffing levels permit). Currently, children requiring the facilities of a Paediatric Intensive Care Unit in North Wales are stabilised and then transferred, usually to the PICU at Alder Hey Hospital in Liverpool. Therefore, none of the three hospitals currently have PICU facilities. YG and YGC also have a HDU cubicle to stabilise children prior to transfer to PICU. All three hospitals have Cardiac Care Unit facilities, with YG and YGC reporting that they have Rapid Access Chest Pain Clinic pathways in place, with paramedics being trained in the administration of thrombolysis for patients with suspected Acute Myocardial Infarction. 4.3 Models of care All three hospitals use the Manchester Triage System to assess patients presenting at the A&E department and all departments currently employ Emergency Nurse Practitioners (ENP) to support with the assessment and treatment of patients. YG has ENP cover in the A&E department from 08.00 – 21.00, YGC has ENP cover for 8 hrs a day and WM has Author: Siobhan Jones/Claire Jones Date: 10/6/09 Status: Final Version: 2 Page 4 of 18 Intended Audience: Expert & Stakeholder Groups National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales 3.20 whole time equivalent (WTE) ENP’s working at one time, but has 7 WTE trained ENPs. 4.3.1 Trauma team All three A&E departments have a trauma team in place led by a senior clinician. In YG a senior Emergency Department Doctor is the trauma team lead, in YGC it is the most senior Doctor available and in WM the trauma team lead is the Emergency Department Consultant. See appendix 2 for additional information from YGC on their trauma team arrangements out of hours. 4.3.2 Links to GP Out of Hours Appendix 3 provides full details of the Out of Hours Service arrangements across North Wales. YGC currently have GP Out of Hours Services on the hospital site but not co- located with the A&E department. At YG the GP Out of Hours service is co-located next to the A&E dept, and patients are sent directly from A&E triage using agreed protocols (approx 350-400 patients a month). WM GP Out of Hours Service is currently provided from a portakabin on the hospital site, and there are plans to locate the GP OOH service within the A&E Department from April 2009. In YGC, GP’s with Special Interest regularly support A&E staff and in YG GP’s from the OOH service are occasionally called upon to ‘queue bust’. GP’s do not work in the WM A&E department. 4.4 Elective & emergency workload arrangements YG and YGC provided details on their arrangements for elective and emergency workload for individual specialities. In YG for all specialities (except trauma/orthopaedics and obstetrics/gynaecology) on call consultants are not free from their elective responsibilities during day time hours. In YGC, on call consultants are free from their elective responsibilities during day time hours for the following specialities: Trauma/Orthopaedics, Anaesthetics and Urology. On call consultants are not free from their elective work in Vascular, Maxillo-facial, ENT, and Paediatrics. For GI specialties some, but not all consultant are free from elective work when on call. Critical Care at YGC covers elective and emergency work. Obs/Gynae staff are not always free from their elective responsibilities while on call (see appendix 1) 4.5 Access to diagnostics For YG and WM, access to MRI scanning is not available out of hours. In YGC MRI scanning is available out of hours on an on-call basis, via consultant request and for specific conditions. All three hospitals have out-of-hours access to CT scanning, Ultrasound scanning and laboratory investigations with immediate reporting. 4.6 Access to theatres All hospitals reported that fully staffed emergency theatres are available 24/7. WM and YGC have emergency theatre staff on site 24/7 and YG has scrub staff and obstetric ODP Author: Siobhan Jones/Claire Jones Date: 10/6/09 Status: Final Version: 2 Page 5 of 18 Intended Audience: Expert & Stakeholder Groups National Public Health Service for Wales Rapid Review of Hospital Element of Unscheduled Care Services in North Wales on site 24/7 with a further two ODP’s on call.
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