{
  "abstract": "Aims and Objectives Background: National standards mandate Urgent Treatment Centres (UTCs) prioritise minor injuries and illness patients; yet services are frequently burdened by presentations outside this scope. Despite appointment triage by non-clinical navigators, a 2023 audit at our appointment-only, Emergency Practitioner-led UTC in London revealed non-acute wound patients used on average 38.3% of daily appointments (peaking > 50%), directly contributing to 179 minor injuries/illness patients being unable to secure an appointment in one month. Aim: To reduce appointment utilisation by non-acute wound patients from a mean of 38.3% to a target of 20%.Method and Design Methods: Root-cause analysis, informed by stakeholder surveys – including UTC staff, local GPs, and patients - identified inconsistent triage as a key driver. Ishikawa and driver diagrams, utilising survey results, informed possible interventions. Using the Model for Improvement framework, the intervention was refined through iterative Plan-Do-Study-Act (PDSA) cycles over 10 months. PDSA cycle 1 introduced a triage proforma utilised by service navigators during appointment booking, followed by focused redirection of high-frequency service users (PDSA 2). Navigator feedback informed refinement into a tree-branching triage decision tool with clear redirection protocols to appropriate community services, piloted locally (PDSA 3), before full implementation (PDSA 4). Data were analysed using run charts and descriptive statistics.Results and Conclusion Results: The triage decision tool produced a sustained reduction in the non-acute wound appointment burden. The proportion of non-acute wound attendances fell from a 50.3% (n=458) peak pre-intervention to 11.1% (n=98) post-intervention. Run chart analysis confirmed a non-random change with a sustained downward shift in appointment misutilisation below the median. This redirection was achieved without negatively impacting overall appointment availability for other patients. Conclusion: A structured triage decision tool, implemented by non-clinical navigators, is an effective strategy to reduce inappropriate appointment-based UTC attendances. This intervention successfully realigned UTC capacity with its core function, providing an appointment-based service for minor injuries/illness patients.",
  "authors": [
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust"
      ],
      "name": "Virginia Garcia Blanco"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Foundation Trust"
      ],
      "name": "Victoria Mummery"
    },
    {
      "affiliations": [
        "City St George’s, University London"
      ],
      "name": "Sarah-Jane Anscomb"
    }
  ],
  "title": "4116 Reducing the carbon footprint 100-fold: moving to methoxyflurane (Penthrox) for painful procedures in the ED",
  "uid": "7f4d4e72-5c25-5ba3-b896-f7ad964a715f"
}