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