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Temporary Escalation Space (TES) Management

The use of temporary escalation space (TES) is now being recognised as a major risk factor for harm, poor care, and poor patient experience, yet is utilised daily. The need to provide care in a temporary escalation space (TES), previously recognised as corridor care, is a symptom of an increased pressure within the care system. Overcrowding and exit block in EDs are created when demand cannot be managed effectively and capacity does not meet the requirements of the demand, this can include hospital bed base, ED clinical space and the workforce required to provide care. The challenges faced by the EDs is reflected in the inability to receive timely handover of Ambulance conveyances, delaying the ambulance services ability to respond timely to undifferentiated community calls. It is crucial that patients are handed over and ambulance crews are freed up to attend the next emergency call within 45 minutes.

To support the safe management of this, environmental risk assessments have been completed by Care Group Nurse Directors which has identified designated areas deemed the safest option for allocation of TES during hours and out of hours. The risk assessments have guided safe decisions regarding the use of areas including capacity, clinical and safety considerations to be taken when the area is in use.

It is essential to maintain the delivery of high quality care throughout the entire episode of care in TES. The following principles should be followed:

Patient safety is imperative and patient selection is key. All patients who are being considered for this setting must be reviewed against the exclusion criteria outlined in the Trust SOP
The care should be person-centred, focussing on the needs of the individual and ensuring that patient’s preferences and values guide any clinical decisions made
While it is recognised that patient experience will not be optimal, it is important to always maintain privacy and dignity during their episode of care
Easy access to bathrooms should be maintained and hourly comfort rounds should be undertaken. Personal hygiene requirements should be identified
Patients should have access to nutrition, including hot meals and hydration. Reasonable adjustments should be made for any patients identified as requiring support
Patients must be able to get quality sleep in a bed or on a trolley overnight
Communication with patients, families and care partners is essential. There should be regular conversation informing patients about their treatment plan, condition and any progress to moving to a bed or cubicle or to being discharged. Patient confidentiality must be maintained throughout this communication
Clinical staff should maintain regular reviews, observations and NEWS2 scoring of patient’s conditions to identify early any changes or deterioration that may require the patient to be moved to another area of the emergency department. Medications should be given as per prescription plan and should be monitored

It is imperative that we are made aware of any concerns you have or incidents that have occurred whilst patients have been in TES, relating to either staff or patients. Our aim is to make the use of TES as safe as possible for both patients and staff. All concerns will be reviewed by one of the Site Nurse Directors or Deputy Chief Nurses and actioned accordingly.

Please describe the incident or concern you would like to raise – please be as specific and detailed as you can possibly be(Required)

Has the incident been reported through DATIX or Ulysses?(Required)

Yes

I am reporting on behalf of:(Required)

Myself

Someone else

Location of incident / concern you would like to raise – please be specific as to the location of TES(Required)

Which of the following could best describe the incident / concern?(Required)

Inappropriate patient selection for TES

Inability to maintain the patient’s privacy or dignity

Inability to meet patient’s individual needs relating to personal hygiene

Inability to meet the patient’s nutritional needs i.e. access to hot meals and regular drinks

Inability to make reasonable adjustments for patient(s) who require support with feeding

Inability for patient to rest / sleep

Inability to complete regular reviews, observations and NEWS2

Other – please provide details

Please specify(Required)

Your Contact Details

Do you wish to remain anonymous?(Required)

Yes

If you wish to remain anonymous your details will not be shared with anyone else without your permission. We only need you details so we can check in with you, gather further supporting information, give feedback and offer you any support you need.

Your name(Required)

Forename Surname

Your work email(Required)

Your department(Required)

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