Quality statement 9: Urgent care

Quality statement

People approaching the end of life who experience a crisis at any time of day or night receive prompt, safe and effective urgent care appropriate to their needs and preferences.

Quality measure

Measures from End of life care strategy: quality markers and measures for end of life care (Department of Health 2009).

See also quality measures and national indicators for further information.

Structure: Evidence of local arrangements to ensure that people approaching the end of life who experience a crisis at any time of day or night receive prompt, safe and effective urgent care. This should be appropriate to their needs and preferences and delivered within locally agreed timescales.

Process: Proportion of nominated informal carers (such as a family member) of people identified as approaching the end of life, who have information about how to access urgent care in the event of a crisis at any time of day or night.

Numerator – the number of people in the denominator receiving information about how to access urgent care in the event of a crisis at any time of day or night.

Denominator – the number of nominated informal carers (such as a family member) of people identified as approaching the end of life.

Outcome:

a) People approaching the end of life feel that any crisis or need for urgent care was addressed in a prompt, safe and effective way appropriate to their needs and preferences.

b) Carers of people approaching the end of life feel that any crisis or need for urgent care was addressed in a prompt, safe and effective way appropriate to the person's needs and preferences.

See the overview for overarching outcomes.

What the quality statement means for each audience

Service providers ensure that systems are in place to provide people approaching the end of life who experience a crisis at any time of day or night, with prompt, safe and effective urgent care, appropriate to the person's needs and preferences.

Health and social care professionals respond appropriately to crises experienced by people approaching the end of life, at any time of day or night, by providing prompt, safe and effective urgent care, appropriate to the person's needs and preferences.

Commissioners ensure they commission urgent care services that provide people approaching the end of life who experience a crisis at any time of day or night, with prompt, safe and effective urgent care, appropriate to the person's needs and preferences.

People approaching the end of life who experience a crisis at any time of day or night receive prompt, safe and effective urgent care that takes into account their needs and preferences.

Source guidance

Department of Health quality markers and measures for end of life care top ten quality marker for providers 4; and markers and measures 1.16, 1.17, 1.18, 1.19, 1.21, 2.2, 2.11, 3.7, 4.12, 6.7, 7.6, 8.4, 8.5, 8.8, 9.2, 9.3, 9.4, 10.3, 10.4, 10.5 and 10.6.

Data source

Structure: Local data collection.

Process: Local data collection.

Outcome:

a) Local data collection. The NHS Outcomes Framework 2011/12 indicator 4.3 – patient experience of A&E services (not specific to end of life care).

b) Local data collection. Office for National Statistics (ONS) National bereavement survey (VOICES) includes questions on urgent care.

Definitions

A 'crisis' is a significant unplanned event where there is an element of distress or disruption requiring urgent response and appropriate intervention.

The definition of 'prompt' will vary depending on the circumstances of the crisis. Timescales should be determined locally based on need.

In the Royal College of General Practitioners' Urgent and emergency care clinical audit toolkit, reference is made to a definition of urgent care as the range of responses that health and care services provide to people who require – or who perceive the need for – urgent advice, care, treatment or diagnosis. People using services and their families and carers, should expect 24 hours a day, 7 days a week consistent and rigorous assessment of the urgency of their care need and an appropriate and prompt response to that need.

Urgent care may also be described as unscheduled care and includes, but is not limited to, both daytime and out-of-hours GP visits in the community, as well as emergency 999 ambulance response and rapid access care. Urgent care may be provided by a range of professionals across all settings and is delivered in a number of different forms. Settings may include, but are not limited to, primary, secondary, and community-based services.

Coordinated care with effective information sharing is essential to delivering urgent care that takes into account both the needs and preferences of the person approaching the end of life (see quality statement 8 on coordinated care). There must also be adequate provision of appropriate specialist palliative care advice and staff who are responsive to emergency need, including the option for 24 hours a day, 7 days a week access to specialist palliative inpatient care (see quality statements 4, 10 and 16).