Standard 21: Urgent Care

Why it matters. In an urgent care service, the patient who is having a heart attack may arrive behind a patient with a sprain. Sorting patients by clinical urgency on arrival is what makes sure the sickest are seen first.

Sample. Review 20 triage records in the last 3 months, and the triage tool and procedure in use.

1. Each patient is triaged on arrival with a recognised tool.

Method. Check each sampled record for a triage category from the tool.

Evidence to show. Triage record (URG-FRM-001).

Pass when. Every sampled patient has a triage category recorded on arrival.

2. A patient with a potential emergency is seen at once.

Method. Check each emergency-category record for the time seen.

Evidence to show. Triage record (URG-FRM-001).

Pass when. Every emergency-category patient is seen at once.

3. A patient who needs emergency care is sent to hospital without delay.

Method. Check each record for the transfer and its time.

Evidence to show. Triage record (URG-FRM-001).

Pass when. Every emergency transfer is made without delay.

Immediate fail (any one means the criterion is not met)

• A patient with chest pain is left in the waiting room unseen.

Why it matters. Patients who come to an urgent care service need to know whether it can treat them. A service that accepts patients it cannot treat delays them and puts them at risk; one that turns them away without a route leaves them stranded.

Sample. Review the published limits of service, and the routes given for 10 patients with a condition outside the service.

1. The conditions the service can and cannot treat are published, with a date.

Method. Check the published limits for the conditions and the date.

Evidence to show. Published limits of service (URG-POL-002).

Pass when. The limits are published with a current date.

2. The route for a condition outside the service is given.

Method. Check each record for the route given.

Evidence to show. Route for conditions outside the service (URG-FRM-002).

Pass when. Every condition outside the service has a route given.

3. The route is given without delay.

Method. Check the time the route was given against arrival.

Evidence to show. Route for conditions outside the service (URG-FRM-002).

Pass when. Every route is given at once.

Immediate fail (any one means the criterion is not met)

• A patient with a condition the service cannot manage is kept for hours.

Why it matters. An urgent care patient can deteriorate in minutes, such as in cardiac arrest or anaphylaxis. The emergency kit and the team must be ready before the patient arrives, not found during the emergency.

Sample. Review the emergency equipment and drug check for the last 30 days, and the drill record for the last 12 months.

1. Emergency equipment and drugs are checked on a set schedule.

Method. Check the checklist for each scheduled check.

Evidence to show. Daily resuscitation check record (HOS-FRM-013).

Pass when. Every scheduled check is recorded.

2. A trained response team is ready at all times.

Method. Check the rota against the trained staff list.

Evidence to show. Training matrix register (WRK-REG-001).

Pass when. A trained team is on duty at all times.

3. The response is tested in drills.

Method. Check the drill record for the set number of drills.

Evidence to show. Emergency drill register (URG-REG-001).

Pass when. Drills are held at the set frequency with gaps acted on.

Immediate fail (any one means the criterion is not met)

• A defibrillator with flat batteries is used during a cardiac arrest.

Why it matters. Long waits in urgent care cause patients to deteriorate or leave, and they hide problems in the service. Measuring waits and acting when they are too long is how the service keeps them short.

Sample. Review the waiting time register for the last 3 months, and the action taken where the standard was exceeded.

1. Waiting time from arrival to assessment is measured for each patient.

Method. Check the register for a waiting time for each patient in the sample.

Evidence to show. Waiting time register (URG-REG-002).

Pass when. At least 95% of patients have a waiting time recorded.

2. Waiting time is compared with the set standard.

Method. Check each entry against the set standard.

Evidence to show. Waiting time register (URG-REG-002).

Pass when. Every entry is compared with the standard.

3. Action is taken where the standard is exceeded.

Method. Check each exceeded entry for the action taken.

Evidence to show. Waiting time register (URG-REG-002).

Pass when. Every exceeded entry has an action recorded.

Immediate fail (any one means the criterion is not met)

• Waits of several hours are not measured or reported.

Why it matters. A patient who leaves urgent care without clear advice may not know when to come back or what to watch for, and may return too late. Written advice, including when to return, keeps the patient safe after the visit.

Sample. Review the follow-up advice record for 10 patients, and the written advice template.

1. Each patient leaves with written advice.

Method. Check each sampled record for the written advice.

Evidence to show. Follow-up advice record (URG-FRM-003).

Pass when. Every sampled patient has written advice recorded.

2. The advice includes when to return and the follow-up needed.

Method. Check each advice record for both items.

Evidence to show. Follow-up advice record (URG-FRM-003).

Pass when. Every advice record includes both items.

3. Understanding is checked.

Method. Check each record for the understanding check.

Evidence to show. Follow-up advice record (URG-FRM-003).

Pass when. At least 90% of records show the understanding checked.

Immediate fail (any one means the criterion is not met)

• A patient is sent home with no advice on when to return.

Why it matters. Patterns of attendance show where the service is short of staff and which patients keep coming back without their problem being solved. Reviewing them lets the service plan staffing and follow up the patients who need it.

Sample. Review the attendance review for the last 3 months, with the staffing comparison.

1. Attendance patterns are reviewed each period.

Method. Check the review for each period in the 3 months.

Evidence to show. Attendance and repeat attender review (URG-REG-003).

Pass when. Every period has a review recorded.

2. Attendance is compared with staffing.

Method. Check each review for the staffing comparison.

Evidence to show. Attendance and repeat attender review (URG-REG-003).

Pass when. Every review includes the staffing comparison.

3. Repeat attenders are identified and followed up.

Method. Check each repeat attender for the follow-up.

Evidence to show. Attendance and repeat attender review (URG-REG-003).

Pass when. Every repeat attender has a follow-up recorded.

Immediate fail (any one means the criterion is not met)

• The same patient attends six times in a month with no review.

Why it matters. A patient waiting to be seen can deteriorate without anyone noticing. Re-checking each waiting patient at a set interval, and recording it, catches the patient who is getting worse before it is too late.

Sample. Review the re-check procedure and 10 re-check records for waiting patients.

1. Each waiting patient is re-checked at the defined interval.

Method. Check each sampled waiting patient for re-checks at the interval.

Evidence to show. Waiting-room re-check record (URG-FRM-004).

Pass when. At least 95% of waiting patients are re-checked at the interval.

2. Each re-check is recorded.

Method. Check each re-check for the record.

Evidence to show. Waiting-room re-check record (URG-FRM-004).

Pass when. Every re-check is recorded.

3. A changed or deteriorating patient is reassessed at once and escalated.

Method. Check each recorded change for the reassessment and the escalation.

Evidence to show. Waiting-room re-check record (URG-FRM-004).

Pass when. Every change is reassessed at once, and every deterioration is escalated.

Immediate fail (any one means the criterion is not met)

• A patient waits three hours with no re-check.

Why it matters. Patients who cannot find the hospital, or reach it by phone, go elsewhere or delay care. Correct, current public information prevents this.

Sample. Review a screenshot or print of each public listing, with the date checked.

1. The name, address, phone number and map location are correct.

Method. Compare each listing with the service’s correct details.

Evidence to show. Public listing check record (URG-FRM-005).

Pass when. Every listing has the correct name, address, phone and map location.

2. The phone number is answered.

Method. Call the listed number at the check.

Evidence to show. Public listing check record (URG-FRM-005).

Pass when. The phone is answered at each check.

3. The services offered are published and current.

Method. Compare the listed services with the current services.

Evidence to show. Public listing check record (URG-FRM-005).

Pass when. Every listing shows current services.

Immediate fail (any one means the criterion is not met)

• The address online is wrong, and the phone is not answered.

Why it matters. When a patient stops breathing, minutes matter. Equipment that is missing or broken, or staff without current life-support training, cost lives.

Sample. Review the resuscitation check sheets for the last 30 days, and the staff certificate list.

1. Resuscitation equipment and emergency drugs are checked on a set schedule.

Method. Check each sheet for the scheduled check.

Evidence to show. Daily resuscitation check record (HOS-FRM-013).

Pass when. Every scheduled check is recorded.

2. The equipment is complete and working, and in a known place.

Method. Walk through and check the equipment and its location.

Evidence to show. Daily resuscitation check record (HOS-FRM-013).

Pass when. Equipment is complete, working and in its known place.

3. Staff who may need the equipment are trained, with current certificates.

Method. Check the staff list against current certificates.

Evidence to show. Training matrix register (WRK-REG-001).

Pass when. Every staff member who may need the equipment has a current certificate.

Immediate fail (any one means the criterion is not met)

• No check record is kept, and untrained staff are on the ward.