‘Ring ahead for A&E to prevent congestion and reduce chaos’
A new ‘phone first’ service aiming to reduce overcrowding in A&E at the University Hospital of Wales (UHW) in Cardiff launches next week. Health correspondent Mark Smith looks at how it will work
PATIENTS who feel they need urgent treatment at A&E will be told to phone ahead under a new system being launched at Wales’ biggest hospital next week.
The CAV24/7 service, which will begin on Wednesday, August 5, is being introduced to help maintain social distancing and manage overcrowding at the emergency unit at the University Hospital of Wales (UHW) in Cardiff.
Anyone who feels they need to visit A&E, but does not have a lifethreatening illness or injury, will be asked to call 0300 10 20 247, where their details will be taken by a trained call handler.
They will then receive a call back from a clinician within 20 minutes for urgent needs, or an hour for less urgent needs, who will “triage” the patient.
The clinician, most likely either a nurse or paramedic, will then give the patient a time slot to visit the emergency department should it be deemed necessary.
However, they may instead opt to send the patient to a minor injuries unit, a GP, pharmacist, or even tell them to stay at home, depending on their condition.
“At the height of the pandemic we saw a significant drop-off in attendances to the emergency unit,” said Dr Sherard Le Maitre, one of the clinical leads for CAV24/7.
“There were initial fears that this meant people were remaining at home who were significantly unwell.
“Analysis of this data showed that this cohort of patients that stopped attending were at the lower-acuity end of the spectrum.
“So we felt this was a safe group of patients to target that could either be managed elsewhere in the health system, or possibly be booked into the emergency department in a managed fashion.”
Dr Le Maitre said the new system, a first for Wales, was developed “from the ground up” in collaboration with colleagues in primary care and those working in the emergency unit.
“A patient being moved from a call handler on to a clinician for triage is not a new type of system. This has been the process for the out-ofhours service for many, many years across Wales,” he stressed.
“We will be monitoring the system as we go along, but we are confident with the degree of training of our staff at all levels. This should provide reassurance to patients that the service is going to be safe.
“This is not about barriers to access, pulling up drawbridges or digging moats around the emergency unit, but about making sure that the individuals who need to access it can be seen in a timely manner.”
One of the main aims of the new service is to reduce the waitingtimes for patients once they arrive in A&E.
Before the pandemic, it was not uncommon for people to spend between four and 12 hours before being admitted, transferred or discharged.
“What has happened in the past is that staff have been unable to predict what is coming in and when, and so sometimes they may have had a large influx of patients who are then sent to different departments, and that can have a knock-on effect [for elsewhere in the hospital].
“So I think this will help give a better experience for patients and prevent the need for many of them to sit down and wait in the emergency department. Instead they can safely wait in their own homes before attending.”
However, Dr Le Maitre stressed that those who need an emergency call for conditions such as suspected heart attacks or strokes should not be calling CAV24/7 and should be dialling 999 inistead.
“This does not replace anybody that has a genuine medical emergency from attending the emergency department or calling 999.”
Despite CAV24/7 being a “phone first” system, there will still be senior medics at the front door of A&E should anyone turn up without a booking.
Dr Le Maitre added: “As things stand at the moment you have to have a temperature check [before you can enter]. These individuals at the front door will make a quick assessment and will determine whether the patient needs a timely emergency unit response.
“There may be a situation where the emergency unit is full, and so to prevent people queuing and waiting outside the door they may be advised, if it is safe to do so, to call CAV24/7 and they may be given an appointment at a later date.”
The “ethos” of the new service is to ensure it is clinically driven, with those in the greatest need given the earliest appointment slots, Dr Le Maitre added.
“Obviously we also have to take into account people’s physical distance to the hospital so we don’t give them an unrealistic appointment time.”
From Wednesday, August 5, a team of call handlers will be based at Barry Leisure Centre to start their roles, while triage clinicians will work from an office at Cardiff Royal Infirmary.
A so-called “flight controller”, such as a GP or other senior clinician, will be on hand to provide expert advice and move resources around should the team need it.
Danielle James, the new operational manager for CAV24/7, said both out-of-hours and emergency unit data were analysed to assess how busy the service could get.
“We also have to map that out over different periods of the year, as demand can alter between summer and winter,” she said.
“There is a well-recognised system which will then work out how many call handlers and how many clinicians are needed.”
She said on a typical day the service would expect to deal with 700800 calls from residents across Cardiff and the Vale of Glamorgan.
“We would have about 25 nonclinical members of staff per 24 hours, and around about 30 clinical members of staff,” she confirmed.