Emergencies are requests for clinical work that cannot be seen soon enough in a routine Choice appointment. The longer your waits the more referrals will be defined as emergency. Some services have “carved out” (see Demand and Capacity pdf downloadable) priority time i.e. fixed slots in individual or team diaries.

From our experience of operating a service with carved out crisis time you tend to be less critical of what constitutes a crisis or emergency. This leads to a higher rate of crisis cases seen and you find a lot of them do not actually meet crisis criteria. Audit in 2001 in Richmond of a system of urgent appointments showed that many that were seen were not urgent and many that were deemed ‘routine’ were actually urgent! Better to have a system that has short waits for everyone with only a few, tight emergency criteria.

The benefits of carving out time is that time is available for the emergency work, but the loss is that the time may be inefficiently used. However if you DO have a reliable rate of emergency activity it may help to job plan this for individuals or sub teams pro-rata-ing the time.

Next up system

This is a rota that has clinicians’ names in order. The person at the top of the rota is responsible for the first overdose that comes in. If two in the same day then the first and second person etc.

We find that on really busy days another mem- ber of the team who has a cancellation is often happy to swap as they get to come off the rota by working when they are less busy. However at worst it might mean cancelling and rebooking more routine clinical work. Workloads are equita- ble with this system but problems can arise if the rota jumps over someone who is away and then you forget to backtrack on their return. Monitor- ing required!

Duty rota

You may choose to have a named person on duty every day, with a second backup. The advantage is it is always clear when it is your turn; however, you may be very busy if 5 come in that day! It also requires close monitoring to ensure that staff swap duty for leave periods. Plus the time may not be used creating inefficiencies.

A key decision in any rota system is how much predictable work is there? If a fair bit then allocat- ing time to the duty activities will be reasonably efficient as well as reducing staff stress i.e. not having to squeeze things in. If there is little pre- dictable activity then the best thing might be to just slot any priority appointment into our diary. This may mean rebooking a routine appointment or using time allocated for admin or a meeting, taking this time back at a later date.

Protected time

If you have regular and predictable heavy de- mand for, say, hospital self harm assessments you may find it works best to have protected time in job plans. However, avoid keeping emergency slots free unless you know the demand and ca- pacity are matched as the result could be unused capacity.

Duty/liaison posts

Some teams decide that it is easiest to have someone whose role is to do all the duty work or hospital work. Whilst this frees the rest of the team form sometimes unpredictable work it can be a stressful role and begin to de-skill the rest of the staff group.