Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

ANNEX 6

A & E SERVICES
A MODEL FOR GAUGING FUTURE FLOWS

The absence of sophisticated data collection systems in A & E Departments makes it difficult to assess future figures. The model below is based on a one week survey of A & E attendances in 1998. There is some mismatch between survey data and the way the Ambulance Service classifies between Urgent Calls and Emergency Calls. All ‘Urgent Calls’ will be from GPs but some 999 calls will also be for very urgent GP referrals. Column (b) extrapolates from the one week survey and column (c) nets (b) off from the total of annual Emergency Calls and Urgent Calls recorded by the Ambulance Service.

Table A

(a)

(b)

(c)

(d)

(e)

Hospital

Total A & E

Attendances

Of which

Children =

GP

referrals =

999 Ambulance

Cases (adults)

Net Total

(a – (b+c+d)

1. Victoria

75,000

14,000

8,320

7,644

45,036

2. Western

55,000

1,200

12,012

8,632

33,156

3. Stobhill

45,000

9,800

8,944

845

25,411

4. GRI

68,000

7,000

8,892

14,891

37,217

5. Southern General

40,000

7,400

6,136

5,034

21,430

6. TOTAL

283,000

39,400

44,304

37,046

162,250

Column (a) includes children who attend adult A & E Departments. Most children presenting at the Western A & E Department are directly referred to the Yorkhill A & E Department. A specialist review group on children’s A & E services in Glasgow recently advised that all children should attend the Yorkhill A & E Department (which is receiving additional staffing) and should not be seen in adult A & E Departments. It also estimated that around 10,000 of all current children attending A & E Departments (Yorkhill included) had injuries or illnesses that could be managed within primary care. As the data in column (d) in Table B implies, that might be an underestimate. 10,000 children between 220 GP practices implies about one child per practice per week. Even if it were as high as 30,000 that would still equate to around 3 children per practice per week.

Based on the 1998 one-week survey the approximate number of children currently attending each adult A & E Department would be:

TABLE B

 

(a)

(b)

(c)

(d)

 

In one week

Survey

Extrapolated

to one year

Number in column (a)arriving by ambulance

Extrapolated to one year

Victoria

268

14,000

12

624

Western

24

1,200

1

52

Stobhill

188

9,800

5

260

GRI

135

7,000

15

780

Southern General

143

7,400

3

156

   

39,400

 

1,872

The figure in column (b) is slightly higher than that identified by the Paediatric A & E Review Group but is broadly reconcilable with their figures (they suggested a range of 32,000 to 37,000) which were themselves approximations. The low figure in column (d) suggests that the number of children who could in future be treated closer to their homes if primary care were organised and resourced to provide a "walk-in" service is potentially quite high.

In interpreting scenarios in the model, the impact of the vast majority of children being seen in Yorkhill’s A & E Department (or more likely, in an extended primary care service) is netted off. This is shown in column (b) in Table A.

Scenario 1 – Conservative about Minor Injuries (cuts, sprains, grazes and bruises and virtually

nothing else. See Exhibit 2 of 1996 Audit Commission Report on A & E Services) with flows based on Ambulance Service view of catchments

i) Assume that figures in column (c) go to separate Emergency Receiving Units at GRI,

Gartnavel and Southside Hospital.

  1. Assume only 33% of column (e) is treated in Minor Injuries Units.
  2. Assume that this is what gets treated at Victoria, Stobhill and Gartnavel Minor Injuries Units (i.e. 33% of 1(e), 3(e) and 2(e).
  3. Assume that for 1(d), 65% goes to GRI, 35% to Southside Hospital.
  4. Assume that for the balance of 1(e), 62% goes to GRI, 38% to Southside Hospital.
  5. Assume that for 2(d), 7% goes to GRI, 93% to Southside Hospital.
  6. Assume that for 2(e), 2% goes to GRI, 98% to Southside Hospital.
  7. Assume that for 3(d) and the balance of 3(e) 100% goes to GRI.

The percentages in (iv) to (vii) reflect ambulance service advice as to where they would take patients in future. Those new "catchments" are then applied to data from the one week survey which showed ambulance arrivals for each hospital by originating postcode and non-ambulance arrivals by originating postcode.

This scenario would see:

Minor Injuries Cases

Victoria   

14,900

Gartnavel 

10,900

Stobhill   

8,400

 

34,200

 

(f)

(g)

(h)

 

Current adult A & E attendances (GRI and SGH) less GP referrals

Flows from other

Hospital areas

(excl. GP referrals)

Total

Southside

26,464

43,966

70,430

GRI

52,108

42,558

94,666

Of the figures in column (h), a minimum of 12,300 (GRI) and 7,100 (Southside) would be treated in the hospital’s Minor Injuries Unit (assuming 33% of Table A, column (e) is ‘minor injuries’).

In addition to a conservative assumption about self-referral and\or triage into minor injuries units, this model also pessimistically assumes that patients choosing to go under their own travel arrangements to GRI or Southside who would formerly have gone to the Victoria, Western or Stobhill do not turn out to be treatable in a Minor Injuries Unit. This is a highly pessimistic assumption. If 10% of those accounted for by assumptions (v) and (vii) above turned out to be suitable for treatment in a Minor Injuries Unit, the total treated in the GRI and Southside Hospital’s Minor Injuries Units would be:

GRI 12,300 + 4,300 = 16,600

Southside 7,100 + 4,400 = 11,500

Scenario 2 – As before but a modest increase in suitability for Minor Injuries treatment

Same as 1, except assume that 40% of column (e) in Table A is treated in Minor Injuries Units.

This scenario would see

Minor Injuries Cases

Victoria   

18,000

Gartnavel   

13,300

Stobhill   

10,200

   

41,500

 

(f)

(g)

(h)

 

Current adult A & E attendances (GRI and SGH) less GP referrals

Flows from other

hospital areas

(excl. GP referrals)

Total

Southside

26,464

40,436

66,900

GRI

52,108

38,788

90,896

Of the figures in column (h), a minimum of 14,900 (GRI) and 8,600 (Southside) would be treated in the hospital’s Minor Injuries Unit (assuming 40% of Table 1, column (e) is ‘minor injuries’).

Like Scenario 1, this model is also pessimistic about patients "diverting" from other hospital catchment areas and travelling under their own arrangements being suitable for Minor Injuries treatment. 10% of those patients would equate to around 3,200 at GRI and 3,000 at Southside Hospital being suitable for Minor Injuries treatment.

Scenario 3 – As before but with 60% of patients suitable for treatment in Minor Injuries Units

Minor Injuries Cases

Victoria   

27,000

Gartnavel   

19,900

Stobhill   

15,200

   

62,100

 

(f)

(g)

(h)

 

Current adult A & E attendances (GRI and SGH) less GP referrals

Flows from other

hospital areas

(excl. GP referrals)

Total

Southside

26,464

30,548

57,012

GRI

52,108

28,076

80,184

Under column (h), a minimum of 22,300 (GRI) and 12,900 (Southside) would be treated in the hospital’s Minor Injuries Unit (assuming 60% of column (e) is ‘minor injuries’). If 10% of those diverting from other hospitals were also Minor Injuries, the total treated in the GRI and Southside’s Minor Injuries Units would be:

GRI 22,300 + 2,500 = 24,800

Southside 12,900 + 2,000 = 14,900

Scenario 4 – Same Minor Injuries treatment rate as Scenario 1 (33%)

but more patients going to GRI

Assume that flow from Western Infirmary is not in 90 : 10 Southside : GRI ratio range seen in Scenarios 1 to 3, but 50 : 50 Southside : GRI.

Also assume that flow from Victoria Infirmary is not in the 35 : 65 Southside : GRI ratio range seen in Scenarios 1 to 3, but 25 : 75 Southside : GRI.

This is a combination of assumptions that is different from the ambulance service view of how they would carry their patients (equating to around 10% of current total A & E attendances at the Victoria and 16% of current attendances at the Western). It also assumes that all patients currently living east of Anniesland and at Bearsden\Milngavie would. All go to GRI. Likewise it assumes that not only do all patients from Govanhill, Rutherglen, Cambuslang, Toryglen, Cathcart, Castlemilk and Gorbals but half of those from Pollokshaws, Newlands, Giffnock, Clarkston and Newton Mearns also go to the GRI rather than to, for the purposes of illustration, Southern General. It is improbable that so many people from these places would actually make that choice. Nevertheless the scenario is useful in showing the upper limits of probability of burden on the GRI.

Minor Injuries Cases

Victoria 14,900

Gartnavel 10,900

Stobhill 8,400

34,200

 

(f)

(g)

(h)

 

Current adult A & E attendances (GRI and SGH) less GP referrals

Flows from other

hospital areas

(excl. GP referrals)

Total

Southside

26,464

24,889

51,353

GRI

52,108

61,635

113,743

 

 

 

 

 

 

 

 

 

Scenario 5 – As Scenario 4 (i.e. upper limits of probability of flows to GRI)

but with high level of Minor Injuries Unit treatment (60%)

Minor Injuries Cases

Victoria 27,000

Gartnavel 19,900

Stobhill 15,200

62,100

 

 

(f)

(g)

(h)

 

Current adult A & E attendances (GRI and SGH) less GP referrals

Flows from other

hospital areas

(excl. GP referrals)

Total

Southside

26,464

17,364

43,828

GRI

52,108

41,260

93,368

Summary of locations of Treatment

 

Scenarios

 

1

2

3

4

5

Victoria - Minor Injuries Unit

14,900

18,000

27,000

14,900

27,000

Gartnavel - Minor Injuries Unit

10,900

13,300

19,900

10,900

19,900

Stobhill - Minor Injuries Unit

8,400

10,200

15,200

8,400

15,200

GRI - Main A & E

82,366

75,996

57,884

101,443

71,068

- Minor Injuries Unit

12,300

14,900

22,300

12,300

22,300

Southside - Main A & E

63,330

58,300

44,112

44,253

30,928

- Minor Injuries Unit

7,100

8,600

12,900

7,100

12,900

 

199,296

199,296

199,296

199,296

199,296

Medical and surgical emergency receiving (GP referrals) will be managed at GRI, Southside and Gartnavel by the medical and surgical receiving teams. The position of children (39,400 currently treated at adult A & E Departments) depends on the development of services at Yorkhill and in primary care but since the number of children arriving by ambulance is around 5%, this suggests that if parents continue to take their child to the nearest hospital regardless of advice, the impact is likely to fall on local Minor Injuries Units and not on GRI or the Southside Hospital’s main A & E Departments.

Conclusions

Of these Scenarios we would regard something between Scenarios 2 and 3 to represent the highest probability of how people behave in practice in terms of self-referral judgements and travel.

The key issues in debate concerned the capacity of the GRI A & E Department. What will be needed is:

Scenario

2 3

Minor Injuries 14,900 22,300

Main A & E 75,996 57,884

Total 90,896 80,184

 

In addition the hospital would have to provide space for the reception of medical and surgical emergency admissions referred by GPs. Further discussion is needed about the probabilities of having to manage children but we would expect anyway a separate space to be provided for children, with staff trained to care for children.

 

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