Background

"Emergency medicine is a medical specialty - a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development." International Federation for Emergency Medicine (2008)

The World Health Organisation describes Emergency Medicine (EM) as “a global discipline that provides secondary disease prevention and is also a tool for primary prevention. It is an integrated system of emergency care consisting of access to EM care; provision of EM care in the community and during transportation of patients; and provision of care at the receiving facility or hospital emergency department”.

The term Emergency Care includes all emergency medicine services, pre-hospital care, Emergency Departments (ED), Injury Units and the initial stages of management of patients who present in need of emergency or urgent care. It also includes ED Clinical Decision Units which are inpatient services led by Consultants in Emergency Medicine. Voluntary organisations and General Practitioners who provide immediate care for communities are also contributors to emergency care. Our aim must be to provide seamless high quality emergency care through systems that are characterised by effectiveness, efficiency, accountability, sustainability, resilience and high levels of staff morale

Aim

The aim of the EMP is to improve the safety and quality of patient care in Emergency Departments (EDs) and Injury Units (IUs) to reduce waiting times for patients.

Approach

The Programme is led by a multidisciplinary working group that includes Consultants in Emergency Medicine, Emergency Nurses, the President of the Irish Association for Emergency Medicine and the Therapy Professions. It is supported by the Irish Committee for Emergency Medicine Training, the Pre-Hospital Service, the Office of the Nursing and Midwifery Services Director and the Clinical Design and Innovation (CDI) of the Health Service Executive (HSE).

The Programme working group is also supported by an advisory group drawn from the relevant training bodies and other stakeholders, a Nurse Reference Group as well as subgroups for Advanced Nurse Practitioners,  Injury Units and Clinical Facilitators. The involvement of patient advocacy group representatives is crucial to the development of the Programme's work. The implementation of Clinical Programmes across a range of specialties has opened up new channels of communication between clinical specialties, services and interest groups. The collaboration that has occurred to date, and that is planned for the future, offers an unprecedented opportunity for the development of truly integrated systems of patient care.

Objectives/Key Solution Areas

The objectives of the National Clinical Programme in Emergency Medicine are to:

• Define a National Emergency Care System comprising networks of EDs fully integrated with pre-hospital and hospital-based services, ensuring a standardised approach to the delivery of high quality emergency care
• Increase patient access to Consultant-led care through increased Consultant numbers and expanded hours of Consultant presence in EDs
• Develop roles for nurses including Staff Nurses, Clinical Nurse Specialists and Advanced Nurse Practitioners, for Therapy Professionals, Medical Social Workers and other members of the multidisciplinary team
• Implement new clinical governance structures and processes to ensure clear authority, accountability and responsibility across the emergency care system
• Integrate implementation of the Emergency Medicine Programme with all relevant programmes, particularly Acute Medicine, Surgery, Critical Care, Paediatrics and Neonatology, Older People Clinical Programme, Medicine for the Elderly and Radiology

The work of the Emergency Medicine Programme is ongoing and the list of outputs is growing constantly. For latest updates and a repository of clinical guidelines, please visit www.emnow.ie.