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COVID-19: resetting ED care
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  • Published on:
    Triage portals in to A&E departments
    • Prasanna N. de Silva, Consultant Old Age Psychiatrist Cumbria, Northmberland, Tyne and Wear NHS Foundation Trust

    What this proposed reset does not describe is a reorganisation of 'at the door' triage based on the type of presentation.
    The need for effective patient throughput (patient flow); the major problem in contemporary A&E (at least pre Covid19) has not been addressed.
    I propose triaging 'at the door' carried out by nurse practitioners (assisted by paramedic crews bringing patients in) and admin staff to access medical information rapidly (for example via the Great North Care Record). These insights were gained from camp Bastion in Afghanistan.

    There should be 4 key portals and pathways thereafter.
    a) The seriously ill (Major Trauma, Sepsis, Stroke, Cardiac Infarcts, Acute Abdomens etc.)
    b) Cases of frailty (mainly elderly people, including delirium / dementia, minor trauma)
    c) mental Health presentations (of all ages, including learning disability)
    d) overspill from General Practice

    These pathways would be staffed by specialist nurse practitioners, pharmacists and speciality doctors, working on prearranged algorithms with electronic prescribing and discharge / handover templates (ideally in a SBAR format) to assist patient flow. cross referral (called scaffolding in mental health) should be possible on occasion. Overall, a duty matron should keep overall control of activity through an electronic dashboard. Paramedic / ambulance crews should have access to this matron remotely to make crucial d...

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    Conflict of Interest:
    None declared.