Read Standard 10: Emergency care

Congenital heart disease (CHD) standards
Healthcare Improvement Scotland

Standard statement

NHS boards ensure that emergency care for people with CHD is safe and effective.

Rationale

Access to information enables safe and effective care for people in emergency departments. This is enhanced by shared digital systems containing up-to-date information. Information about a person’s diagnosis, interventions and drug treatment should be available at all times,76 across and between all NHS boards.

Access to up to date scans and tests, including echocardiograms and device monitoring, facilitates timely treatment and diagnosis. This enhances patient safety in high risk emergency situations. Immediate and easy access to congenital cardiology advice should be available. Remote, real-time, review of echocardiograms and ECGs facilitates safe care of newborn infants with suspected CHD and minimises unnecessary transfers. Effective and timely referral pathways from emergency departments to the national service are essential for patient safety.

Criteria

10.1

Each emergency department can access immediate up-to-date clinical information about people with CHD from all NHS boards and services including the national services.

10.2

Each emergency department is provided with nationally consistent and immediately accessible information on how and when to access specialist advice including from the national services if required.

10.3

Each emergency department, including the maternity assessment unit, has clearly defined protocols for referral and escalation which provide information on:

  • out of hours access
  • guidance for referrals
  • local, regional and national services
  • transport to the national services if required
  • roles and responsibilities including key decision makers
  • care pathways specific to paediatric and neonatal cases
  • emergency non-cardiac presentations requiring anaesthetic or obstetric input.
10.4

NHS boards have guidance for the recognition and care of pregnant women/ people with CHD attending maternity assessment units or emergency departments.

10.5

High quality imaging including echocardiograms can be accessed and shared in a timely manner across all NHS boards and services, including the national services.

10.6

NHS boards have processes and referral pathways in place to facilitate safe, out of hours management of:

  • people with heart rhythm emergencies
  • suspected failure of cardiac devices.
10.7

Key information summaries for people with CHD are available to ambulance staff and emergency department staff.

10.8

People with CHD are signposted to an identifiable marker including clinical alerts or medical information bracelets where appropriate.

10.9

People with CHD have an emergency care plan, if required, which:

  • is immediately accessible and shared electronically
  • is developed in partnership with their specialist team
  • is shared with the person and held individually
  • includes emergency contact details
  • is accessible by all emergency departments
  • highlights additional needs including communication needs
  • details their wishes and preferences in relation to resuscitation.
10.10

People with CHD who receive emergency care and their families/representatives are offered inclusive information in a format and language that is right for them about:

  • their rights
  • the rights of their families/representatives
  • feedback and complaints procedures
  • who to talk to if they have any concerns about their health
  • support organisations or groups they can talk to about their experience.
10.11

NHS boards provide staff in emergency departments with:

  • key resources including condition- and patient-specific information in a timely manner
  • training, relevant to their roles and responsibilities, about potential risks and safety protocols for people who have CHD
  • information on how and when to access local and national specialist information and support
  • training relevant to their roles and responsibilities on the specific needs of people with chromosome-related conditions who have CHD.
10.12

Information on a person’s attendance in an emergency department is proactively shared with relevant staff on discharge, to support onward planning and support.

What does this standard mean for...

What does the standard mean for the person receiving care?

  • Staff in emergency departments are aware of your condition and how to safely look after you.
  • Important information about you is immediately available to people who need it.
  • You will be listened to and taken seriously by healthcare professionals.
  • You will receive accessible information about why you were in an emergency department and what might happen next.

What does the standard mean for staff?

Staff:

  • • have immediate access to future care plans
    • receive immediate clinical information about people with CHD who attend an emergency department
    • know when and how to access specialist support or advice, including from the national services.

What does the standard mean for the organisation?

NHS boards:

  • have established pathways and procedures for emergency departments to ensure safe, effective and person-centred care of people with CHD
  • work collaboratively to share relevant information
  • develop, improve and update systems to ensure immediate access to clinical information.

Examples of what meeting this standard might look like

  • Consistent guidance or clinical pathways for emergency care.
  • Local decision-making charts and procedures.
  • Shared digital systems.
  • Agreed referral pathways, documentation on escalation procedures and safety planning.