Emergency and acute medical care in over 16s: service delivery and organisation

This guideline covers organising and delivering emergency and acute medical care for people aged over 16 in the community and in hospital. It aims to reduce the need for hospital admissions by giving advanced training to paramedics and providing community alternatives to hospital care. It also promotes good-quality care in hospital and joint working between health and social services.

Contents

• Guideline
  • Overview
  • Context
  • Recommendations
  • Putting this guideline into practice
  • Recommendations for research
  • Update information
• Chapter 1. Guideline introduction
  • Acknowledgements
  • 1. Introduction
  • 2. Guideline summary
  • 3. Development of the guideline
  • 4. Methods
  • 5. Reference list
  • 6. Acronyms and abbreviations
  • 7. Glossary
• Chapter 2. Non-emergency telephone access and call handlers
  • Non-emergency telephone access to urgent or unscheduled care
  • Call handlers
  • References
  • Appendices
• Chapter 3. Paramedics with enhanced competencies
  • 3. Paramedics with enhanced competencies
  • References
  • Appendices
• Chapter 4. Paramedic remote support
  • 4. Remote access to clinical advice by ambulance staff
  • References
  • Appendices
• Chapter 5. GP extended hours
  • 5. GP extended hours
  • References
  • Appendices
• Chapter 6. GP-led home visits
  • 6. GP led home visits
  • References
  • Appendices
• Chapter 7. GP access to laboratory investigations
  • 7. Primary care access to laboratory investigations
  • References
  • Appendices
• Chapter 8. GP access to radiology
  • 8. Primary care access to radiology
  • References
  • Appendices
• Chapter 9. Community nursing
  • Nurse-led community care
  • Extended access to community nursing
  • References
  • Appendices
• Chapter 10. Community-based pharmacists
  • 10. Community-based pharmacists
  • References
  • Appendices
• Chapter 11. Social care extended access
  • 11. Extended access to social care services
  • References
  • Appendices
• Chapter 12. Alternatives to hospital care
  • 12. Alternatives to hospital care
  • References
  • Appendices
• Chapter 13. Community rehabilitation
  • 13. Community rehabilitation
  • References
  • Appendices
• Chapter 14. Community palliative care
  • 14. Community palliative care
  • References
  • Appendices
• Chapter 15. Advance care planning
  • 15. Advance care planning
  • References
  • Appendices
• Chapter 16. Emergency department opening hours
  • 16. Emergency department opening hours
  • References
  • Appendices
• Chapter 17. GPs within or on the same site as emergency departments
  • 17. GPs within or on the same site as the Emergency Department
  • References
  • Appendices
• Chapter 18. Minor injury unit, urgent care centre or walk-in centre
  • 18. Minor injury unit, urgent care centre or walk-in centre
  • References
  • Appendices
• Chapter 19. Early versus late consultant review
  • 19. Early versus late consultant review
  • References
  • Appendices
• Chapter 20. Physician extenders
  • 20. Physician Extenders
  • References
  • Appendices
• Chapter 21. Standardised criteria for hospital admission
  • 21. Standardised criteria for hospital admission
  • References
  • Appendices
• Chapter 22. 7-day diagnostic radiology
  • 22. 7-day diagnostic radiology
  • References
  • Appendices
• Chapter 23. Liaison psychiatry
  • 23. Liaison psychiatry
  • References
  • Appendices
• Chapter 24. Assessment through acute medical units
  • 24. Acute medical units
  • References
  • Appendices
• Chapter 25. Admission through elderly care assessment units
  • 25. Admission through Elderly Care Assessment Units
  • References
  • Appendices
• Chapter 26. Frequency of consultant review
  • 26. Frequency of review by a consultant
  • References
  • Appendices
• Chapter 27. Critical care outreach teams
  • 27. Critical care outreach teams
  • References
  • Appendices
• Chapter 28. Structured ward rounds
  • 28. Structured ward rounds
  • References
  • Appendices
• Chapter 29. Multidisciplinary team meetings
  • 29. Multidisciplinary team meetings
  • References
  • Appendices
• Chapter 30. Pharmacist support
  • 30. Pharmacist support
  • References
  • Appendices
• Chapter 31. Enhanced inpatient access to physiotherapy and occupational therapy
  • 31. Enhanced in-patient access to physiotherapy and/or occupational therapy
  • References
  • Appendices
• Chapter 32. Structured patient handovers
  • 32. Structured patient handovers
  • References
  • Appendices
• Chapter 33. Integrated patient information systems
  • 33. Integrated patient information systems
  • References
  • Appendices
• Chapter 34. Standardised systems of care for intra- and inter-hospital transfers
  • 34. Hospital transfers
  • References
  • Appendices
• Chapter 35. Discharge planning
  • 35. Discharge planning
  • References
  • Appendices
• Chapter 36. Standardised discharge criteria
  • 36. Standardised discharge criteria
  • References
  • Appendices
• Chapter 37. Post-discharge early follow-up clinics
  • 37. Post-discharge early follow-up clinics
  • References
  • Appendices
• Chapter 38. Integrated care
  • 38. Integrated care
  • References
  • Appendices
• Chapter 39. Bed occupancy
  • 39. Bed occupancy
  • Appendices
  • References
• Chapter 40. Escalation measures
  • 40. Escalation measures
  • References
  • Appendices
• Chapter 41. Cost-effectiveness analyses
  • 41. Cost-effectiveness analyses
  • 41.7. References
  • Appendices

Final

Developed by the National Guideline Centre, hosted by the Royal College of Physicians

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Your responsibility: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.