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S U R V E Y O F S E L F – R E F E R R A L P A T IE N T S A T S E L E C T E D
N H S G G C A & E D E P A R T M E N T S
G R A N T A R C H IB A L D
D IR E C T O R
E M E R G E N C Y C A R E A N D M E D IC A L S E R V IC E S
BACKGROUND
NHSGGC - 2009-10 – 469,048 NEW ATTENDERS
APPROXIMATELY 75% ARE SELF REFERRALS
RANGES BETWEEN 66% ( WIG ) AND 85% ( SGH )
PERCEPTION THAT MOST OF THESE ATTENDANCES ARE CLINICALLY APPROPRIATE BUT THAT THERE IS LITTLE CONTROL OVER THE PROCESS
PATIENT PATHWAYS SURVEY JOINTLY COMMISIONED WITH EADT IN JAN
2010
BACKGROUND TO THE SURVEY
4 SITES SELECTED :
GLASGOW ROYAL INFIRMARY WESTERN INFIRMARY VICTORIA INFIRMARY ROYAL ALEXANDRA HOSPITAL
ALL SITES ARE MAJOR A&E CENTRES DEALING WITH MAJOR TRAUMA, ETC
AND SEEING 60-75K NEW A&E ATTENDERS PER ANNUM
SURVEY TOOK PLACE BETWEEN 18 JANUARY AND 07 FEBRUARY 2010
INTERVIEWS TOOK PLACE BETWEEN 1000HRS AND 2000HRS
1011 INTERVIEWS WERE COMPLETED
REPRESENTS APPROX 30% OF SELF REFERRALS AT THE 4 SITES DURING THE PERIOD IN QUESTION
DEMOGRAPHICS
SURVEY SAMPLE WAS 50 / 50 SPLIT BETWEEN MALE AND FEMALE
20% OF THE RESPONDENTS WERE OVER 55YRS OLD
90% OF RESPONDENTS WERE WSE / 3% WERE BME / 7% WERE WHITE OTHER
UNDER 45% IN FULL TIME EMPLOYMENT
GRI Western RA Victoria
% % % %
Decile 1 38 19 14 25
Deciles 2-3 12 18 25 15
Deciles 4-5 11 15 16 16
Deciles 6-7 10 9 11 17
Deciles 8-9 6 14 10 11
Decile 10 2 6 3 5
(Unknown) 20 19 21 9
DEPRIVATION LEVELS OF RESIDENT POPULATION A MAJOR FACTOR AT ALL SITES.
AT GRI RESPONDENTS WERE 4 TIMES MORE LIKELY THAN THE SCOTTISH AVERAGE TO COME FROM THE MOST SOCIALLY DEPRIVED BACKGROUNDS
ACCESSIBILITY
Travel to A&E % Cost %
Own car 28 £0 34
Lift from friend / family 38 £0.01 - £2.00 8
Taxi 15 £2.01 - £5.00 21
Bus 8 Over £5 9
On foot 9 Don’t know 28
Journey Time (minutes)
Up to 10 46
11 - 20 38
21 - 30 10
Over 30 5
84% OF RESPONDENTS LIVE WITHIN 20 MINS TRAVEL TIME OF AN A&E DEPT
LOCAL VARIABILITY ON PUBLIC TRANSPORT USAGE ( 8% BUS OR WALKED TO RAH
WHILE 29% FOR WIG )
EASE OF ACCESS SEEMS TO BE A MAJOR FACTOR IN USE OF A&E PARTICULARLY WHEN COMIBINED WITH HIGH LEVELS OF SOCIAL DEPRIVATION
ABOVE IS EVIDENCED BY NHSGGC HAVING THE HIGHEST RATES OF A&E ATTENDANCE
IN MAINLAND SCOTLAND ( NHSGGC 412 PER K / SCOTTISH AVE 332 PER K )
AWARENESS OF ALTERNATIVES TO A&E
SITE VARIATION WITH DON’T KNOW OF ANY OTHER OPTIONS RANGING FROM 19% AT GRI TO 62% AT VIC
75% OF RESPONDENTS SOUGHT NO OTHER CLINICAL ADVICE PRIOR TO A&E VISIT
AT LEAST 31% OF PATIENTS WHO HADN’T SOUGHT ADVICE BELIEVED THE SEVERITY OF
THEIR CONDITION WARRANTED A VISIT TO A&E
AT LEAST 33% CHOSE A&E ON THE BASIS OF CONVENIENCE ( QUICKER TREATMENT / NEARER / W AIT TOO LONG FOR GP )
LOCAL VARIATION : RAH RESPONDENTS SHOW ED GREA TER BIAS TOW ARDS
CONVENIENCE WHILE W IG HAD GREATER BIAS TOWARDS SELF DETERMINED CLINICAL NEED
IN TERMS OF THE GROUP W HO HAD SOUGHT ADVICE 60% HAD SPOKEN TO EITHER GP
OR NHS 24
HALF OF THIS GROUP W ERE SPECIFICALLY ADVISED TO ATTEND A&E
OF THE PEOPLE CONTACTING THEIR GP, THE M AJORITY W ERE NOT OFFERED AN APPOINTMENT OR W ERE ASKED TO CALL BACK
OF THOSE OFFERED AN APPOINTM ENT ( 33/ 95 ), MOST W ERE GIVEN AN APPOINTMENT
EITHER THE SAME OR NEXT W O RKING DAY
THESE PEOPLE STILL CHO SE TO COME TO A&E
W IG PATIENTS ALSO CHO SE TO COME TO A&E DESPITE A M AJORITY OF THEM BEING OFFERED A GP APPO INTMENT
MOST COMMO N REASON FOR ABO VE BEHAVIOUR - “ W ANTED TO BE SEEN SOONER ”
WILLINGNESS TO USE ALTERNATIVES TO A&E
“ WHICH OF THESE, IF ANY, WOULD YOU HAVE BEEN WILLING TO USE TODAY IF YOU HAD THOUGHT THEY WERE AVAILABLE TO YOU ? ”
69% OF RESPONDENTS FOUND THE OTHER TREATMENT OPTIONS UNDESIRABLE EVEN WHEN PROMPTED
THE MOST SUITABLE ALTERNATIVE WAS GENERAL PRACTITIONER WITH 17% APPROVAL
91% OF ATTENDERS AT RAH WOULD NOT HAVE USED AN OF THE OTHER OPTIONS EVEN IF THEY HAD BEEN AVAILABLE
ONLY 5 OUT OF 24 SITE BASED RESPONSE / ALTERNATIVE SERVICE COMBINATIONS
SECURED OVER 10% APPROVAL
PATIENT SURVEY – ISSUES
PROXIMITY OF THE DEPTS. – 84% OF RESPONDENTS LIVED WITHIN 20 MINS. TRAVELLING TIME OF AN A&E
PERCEPTION OF OPEN ACCESS
SENIORITY OF CLINICIANS
FREE PHARMACEUTICAL TREATMENT
QUICK ACCESS TO DIAGNOSTICS
LOW AWARENESS OF ALTERNATIVES
PERCEIVED DIFFICULTY IN OBTAINING SUITABLE GP APPOINTMENTS
PEOPLE UNHAPPY WITH THE DIAGNOSIS THEY HAVE BEEN GIVEN
ELSEWHERE (2ND OPINION )
CONCLUSIONS
PATCHY KNOWLEDGE OF OTHER TREATMENT OPTIONS
WHERE OTHER TREATMENT OPTIONS ARE AVAILABLE THEY ARE PERCEIVED AS LESS SUITABLE THAN A&E
A SIGNIFICANT NUMBER OF PATIENTS SELF DIAGNOSE WITHOUT SPEAKING
TO ANY HEALTH AGENCY
THERE APPEARS TO BE A PERCEPTION IN SOME COMMUNITIES (PARTICULARLY GRI) OF THE A&E DEPT AS A DROP-IN COMMUNITY HEALTH CENTRE
IN GENERAL TERMS, RELATIVE POVERTY AND ACCESIBILTY ARE KEY ISSUES
IN SHAPING DEMAND FOR A&E SERVICES
CONTRADITIONS WITHIN RESPONDERS OPINION, E.G. 77% BELIEVED A&E SHOULD TREAT EVERYONE WHO ATTENDS WHILE 80% BELIEVED “PEOPLE SHOULD ONLY GO TO A&E IF THEY ARE SERIOUSLY ILL OR HURT”
CURRENT INITIATIVES
PROVIDE MORE EFFECTIVE PUBLICITY TO SERVICE USERS ABOUT THE TREATMENT OPTIONS AVAILABLE TO THEM
WE HAVE ENHANCED THE ROLE OF THE NEW MIU’S - A SNAPSHOT IN SEPT
2010 SHOWED AN 11% INCREASE IN MIU ACTIVITY FROM THE PREVIOUS YEAR
WE HAVE COMBINED POINTS 1 AND 2 ABOVE TO PRODUCE A PROMOTIONAL
DVD FOR THE MINOR INJURIES UNITS
ESTABLISHED A TASK FORCE UNDER THE CHAIRMANSHIP OF RENFREWSHIRE CHP TO REVIEW THE A&E SURVEY FINDINGS IN RELATION TO RAH
WORKING IN CONJUNCTION WITH EADT ON SPECIFIC THEMES OF REPEAT
ATTENDERS, MENTAL HEALTH ATTENDERS AND CHILDREN ATTENDING A&E
CURRENT INITIATIVES ( cotd. )
GPOOH SERVICES COLLOCATED WITH MINOR INJURY UNITS
AT KEY A&E SITES ( WIG / RAH ) – A&E AND MIU HAVE DIRECT REFERRAL TO OOH SERVICE WITHOUT GOING THROUGH NHS 24
ESTABLISHED DIRECT ADMISSION / ASSESSMENT UNITS AT WIG / GRI / RAH
TO FREE UP CAPACITY IN A&E