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Case Study

How Pennine diverted patients away from the ED to improve patient flow

15 Minute Read


The challenge

Health systems around the world are struggling with unprecedented emergency department (ED) pressures, including increasing volumes and long wait times. While ambulatory units are just one of the many options available for providers to refer patients to, ambulatory units are not being used to their full potential as an alternative site of care for patients with non-emergency care needs.

The organization

Pennine Acute Hospitals NHS Trust, a four-hospital health system, is part of the Northern Care Alliance which serves the northeastern sector of Greater Manchester, England.

The approach

Pennine created a short list of exclusion criteria to make ambulatory care the default care pathway for all non-elective patients. Exclusion criteria are hardwired at multiple points of the patient journey to ensure all avoidable admissions are captured.

The result

Using exclusion criteria, Pennine has increased the proportion of its emergency visits managed in ambulatory care from 9% to 25%.



How Pennine diverted patients away from the ED to improve patient flow

Pennine experienced increasing low-acuity presentations to the ED. To manage capacity, they decided to redirect these patients to ambulatory care sites. But clinicians were underutilizing this care site, so patients often ended up in an acute setting by default. To increase ambulatory care use, Pennine decided to radically rethink their approach.


The three steps

Pennine followed three steps to make it easier, and more natural, for staff to send patients to ambulatory care:

  • Step

    Change the default to ambulatory care

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  • Step

    Hardwire the exclusion criteria

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  • Step

    Embed senior clinical decision makers in ambulatory services

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Adding exclusion criteria has improved both efficiency and patient care in the ambulatory service. The goal was for Pennine’s ambulatory care unit to manage 25% of total emergency admissions, a goal the unit met in January 2018.

Beyond the number of patients seen and treated, the ambulatory model has realized several additional benefits. The model improved patient experience by reducing patient wait times in the ED. They also saw a reduction in emergency admissions to the inpatient setting and bed days used.

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