The Scottish Ambulance Service Improving Care, Reducing Costs. Working together for better patient care

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1 The Scottish Ambulance Service Improving Care, Reducing Costs Working together for better patient care

2 Key points The Scottish Ambulance Service is seeing more people, faster, and offering better quality care than ever before. It is also providing services at lower relative cost. Of course ambulance services should be able to quickly respond to emergency calls. At present in the UK they are required to reach 75 per cent of immediately life threatened patients within eight minutes. However, the Scottish Ambulance Service, is so much more than a service that simply takes patients from A to B. We initially and throughout our contact with patients bring high quality care right to the frontline of the NHS. UK NHS ambulance services face some of the most demanding performance targets in the world. Scottish Ambulance Service answers approximately 800,000 calls per year, 600,000 of which receive an emergency response. Over the last decade 999 calls have increased by 4% every year. This equates to about 24,000 extra calls and an additional cost of 4m each year. The Scottish Ambulance Service plays a vital role in ensuring patients are cared for in the most appropriate setting, preventing accidents, promoting public health and working in partnership to make public services more efficient. This factsheet illustrates six important roles the Scottish Ambulance Service plays and how we are helping to ensure patients receive better care. Scottish Ambulance Service is taking a wide range of steps to manage this increased demand. Over the last year, as a result, demand growth has slowed to 1.8%. This is helping to ensure more patients get the right care from the right service at the right time and to bring about efficiency savings throughout the NHS. Working together for better patient care 2

3 Helping Patients to Access the Most Appropriate Services Case Study: Single Common Triage Tool We have developed a specification for a Single Common Triage Tool, with NHS24, which provides a more in depth clinical assessment of non life threatening cases and then refers the caller to the right health professional who can best treat them. This frees ambulances for life threatening cases and ensures that patients get the right care. Enhanced clinical skills are being developed within our call taking and dispatch centres to enable the refined clinical assessment. There are many different parts of the health service, which the public can choose to use when they feel ill. These range from pharmacy services, GP s, NHS24 and Accident and Emergency. The ambulance service operates across the whole country, 24 hours a day, 7 days a week, and the public access on a well known freephone telephone number, 999. The number of 999 calls has been increasing each year, placing huge demands on Accident and Emergency Services. Not everyone who phones 999 however needs to go to hospital, but rather should be treated locally either at home or in alternative facilities. We are working with NHS24, GPs and A&E departments to develop common triage arrangements with access to refer to a range of health professionals. Case Study: Treating Patients in Their Own Home When Fife Community Paramedic, Craig Hutchison, is called to an elderly person who has fallen at home, rather than taking the patient to hospital, Craig checks the person over, confirms the cause of the fall, gives pain relief and stitches if necessary and ensures the patient is advised of what to do next. Craig then visits the patient s GP, provides them with a copy of the patient clinical record, and books a follow up appointment with the district nurse to remove the stitches. Working together for better patient care 3

4 Taking Care to the Patient Case study: Improving end of life care In Tayside, we work closely with Marie Curie and have trained and equipped our patient transport staff in palliative care. These staff convey patients to their chosen place for end of life care, in specially designed ambulances, enabling patient choice and dignity. At present just under 70% of calls to the ambulance service are taken to hospital. For many patients reducing hospital admissions and treating people locally is not only more clinically effective, but is very clearly the patient s preference. Case study: - Treating heart attack patients in the most appropriate setting All Scottish Ambulance Service accident and emergency units have the ability to diagnose heart attacks, through 12-lead ECGs, staff training and diagnostic support from specialists. Patients with serious heart attacks are now taken directly to the very specialist centres that provide life saving emergency treatments such as angioplasty. This is world-class health care, and is contributing to the significant reduction in cardiac deaths in Scotland. The Scottish Ambulance Service is enhancing its skills and equipment and developing new care pathways with the rest of the NHS to treat more people in their own home. Not only does this deliver better care for patients, but it also greatly reduces costs. Reducing the number of patients conveyed to hospital by just 1%, saves the NHS 1m each year. Of course there are still many cases where patients need to go to hospital, sometimes not directly to the local Accident and Emergency, but rather directly admitted to specific hospital departments. Working together for better patient care 4

5 Promoting Public Health Case study Raising awareness of the signs of stroke In 2010, the Scottish Ambulance Service worked with the Chest, Heart and Stroke Association to promote the FAST campaign. This aimed to raise awareness of the signs of stroke. The Face, Arm, Speech and Time (FAST) test is a simple examination to help anyone recognise the symptoms of a stroke. Ambulances were stickered with FAST signage, alongside a wider campaign by Chest, Heart and Stroke. The Scottish Ambulance Service is now getting to people much quicker after they have had their stroke, conveying them into definitive care to allow treatment to start much earlier, and thus reducing the debilitating effects of a stroke. The Scottish Ambulance Service carries out a range of health education programmes, such as life saving skills for school children, first aid for community groups and businesses and campaigns that raise awareness of the symptoms of serious illnesses. Working together for better patient care 5

6 Preventing Accidents Case study reducing hospital admissions for falls In Perth we have introduced a screening questionnaire for all ambulance crews to use when an older person calls after having a fall. Any person with risk factors for future falls is offered referral for falls assessment, and support. For example, one elderly gentleman required alterations to his medication to prevent the low blood pressure which was causing him to fall. The Scheme has been implemented at minimal cost and results in fewer patients being admitted to hospital. Ambulance services have shown that prevention strategies can be very effective in helping people avoid accidents and reducing the number of 999 calls. In particular, joint working across traditional boundaries has shown significant results in reducing the number of falls suffered by older people. Falls are a leading reason for people to call an ambulance, accounting for 12% of all calls. Working together for better patient care 6

7 Safeguarding Vulnerable Children and Adults Case study Protecting vulnerable children and adults Recently within West Central Division, staff from different disciplines within the Service linked up to take action when it was realised that a Diabetic patient was at risk. The patient had required over 70 Emergency Ambulance responses in just 6 months, but rarely travelled to hospital. All vulnerable children and adults have the right to be protected from harm, and NHS organisations have a responsibility to report any incident where there are grounds to suggest that a vulnerable child or adult is at risk of suffering abuse. This is particularly relevant for ambulance services, who, more than any other NHS service, are on the front line and in people s homes. Our Research Paramedic had come across 14 instances involving the patient as part of his Diabetes Research. Almost simultaneously, the Area Service Manager had passed on concerns raised by A&E Crews about the patient to the Clinical Lead. On investigation it became apparent that the patient was clearly at risk. The Clinical Lead and Research Paramedic met with 3 Mental Health Officers the following day and agreed that if the patient calls again the Service would contact the Duty Emergency Social Worker to ensure back up support is provided as soon as possible. Since then the number of emergency calls has reduced substantially and the patient s health seems more stable. Ambulance services throughout the UK have therefore developed processes to ensure that the right agencies receive the right referral and that all information is treated confidentially and sensitively. Working together for better patient care 7

8 Working with Local Communities Case study Working in partnership to benefit communities There are now over 120 Community First Responder Schemes (CFRS) in Scotland. In the island of Luing, with a population of c.200, the CFRS provides essential treatment until the ambulance arrives on the ferry, or the air ambulance touches down. The retained firefighers put out the landing lights for the helicopter and the air ambulance paramedics then take over the care of the patients. In rural and remote areas it is often a challenge to respond quickly to patients who are experiencing a life threatening emergency. In Shetland, the retained ambulance staff provide a second resource for the residents in the main island. The retained staff work closely with the full time crews to keep up their skills and knowledge. In Auchterarder the local BASICs doctor provides an emergency pre-hospital initial response whilst the ambulance is en route. The Scottish Ambulance Service therefore gets into the heart of rural communities and engages local people to work with the Service to deliver effective services. Community First Responders are trained to attend a wide range of emergency calls in their local neighbourhoods and can provide essential life saving treatment like CPR and defibrillation whilst an ambulance is on route. The Scottish Ambulance Service also works with a wide range of organisations, including the other emergency services, to deliver public health initiatives. These help local people to avoid emergency incidents as well as ensure good relationships with other local organisations. Working together for better patient care 8

9 Conclusion Improving Care, Reducing Costs These are just a few examples of how the Scottish Ambulance Service ensures that patients are cared for in the most appropriate setting, prevents accidents, promotes public health and contributes to an efficient NHS. We hope that these help to show the Scottish Ambulance Service in a different light, as a clinically responsive service delivered locally to people throughout Scotland. Across the country there are many other local examples of new ways to deliver NHS services with the ambulance service at their heart. Working together for better patient care 9

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