Ahmed Belim and Val Stoner-Hobbs
General Manager and Lead Nurse,
East Midlands Ambulance Service NHS Trust
Tel: 0115 9296151
Email: val.stoner@emas.nhs.uk
Summary:
The objectives were to expand the operating hours of the East Midlands Ambulance Service (EMAS) Nurse Triage programme to provide 24/7 cover and to enable Emergency Care Practitioners to be deployed to non urgent, non life-threatening 999 calls. The scheme also sought to develop technical links with other Out Of Hours services, increase referral pathways, improve the patient’s experience and maximise patient care.
EMAS is already recognised as the leading Ambulance Trust in the UK for its pioneering work on developing Nurse Triage. We are confident this new development will further enhance our reputation and status.
Abstract:
The aims were to improve the scope of the service, the care provided to patients and build on delivering care in more appropriate places - supporting a ‘Whole Healthcare’ approach. Under the scheme, Emergency Care Practitioners are now specifically targeted to Category C 999 calls and provide care in the community or arrange a direct admission to hospital thus avoiding unnecessary admissions to Accident and Emergency (by streamlining processes and achieving speedier response times).
To ensure that all staff embraced the change programme positively, EMAS’ Nurse Advisors team were (from the inception of the programme) included in discussions about the process we wanted to adopt. Various types of communication were used to help convey information about the scheme supported by staff training so all involved felt confident with new ways of working. Following a pilot phase, we reviewed the outcomes and made further adjustments with agreement of the team. Regular meetings were used to resolve any issues and updates on developments communicated to staff.
This programme was considered to be transformational, rather just another change programme.
To evaluate the programme, statistics are collated and analysed on how many: calls are reviewed by nurses, ambulances actually attend calls, calls are downgraded to urgent status and how many calls are referred to Emergency Care Practitioners, GPs, out of hours services, intermediate care or other health care professionals.
Patient satisfaction surveys are carried out through contacting patients who have used the service and asking them questions over the telephone. EMAS’ Lead Nurse audits a random selection of calls using a call audit tool to measure the standard of assessments, accuracy of documentation and ensure that calls meet the necessary satisfactory criteria. All Nurses reflect whilst taking live calls. We also use peer reflection to identify any learning outcomes and improvements required to achieve high standards of call management.
Good news stories are used to demonstrate the value of the initiative. Also, case study material is used to share best practice and identify areas for ongoing personal and professional development within the Nurse Advisors team and amongst EMAS’ Emergency Care Practitioners.
The introduction of the new role of Emergency Care Practitioner has provided a further career development opportunity for Paramedics to enhance their skills leading to a degree level qualification. We have also developed the Nurse Advisors role to include the deployment of Emergency Care Practitioners to emergency incidents. This allows EMAS to respond to the needs of the public through the referral of patients to a more appropriate care provider. This improves the patient journey and experience.We compare, measure and discuss EMAS’ performance and activity with other ambulance services through national meetings which EMAS hosts and chairs. Our beacon approach to dealing with Category C calls has attracted many visits from other UK Ambulance Trusts who wish to pursue and adopt a similar approach.
Our data indicates that between 600 and 700 emergency ambulance journeys are saved each month providing a more appropriate outcome for the patient with the continuing development of the referral pathways.
By December 2005, analysis showed that 74% of the patients seen by Emergency Care Practitioners have not required the attendance of an emergency ambulance and over 50% did not require hospital treatment. The patient benefits are greater choice of care, a personally focused service, fewer long waits in the A&E Department, quicker delivery of care delivered in a setting more conducive to personal need and direct referrals without attendance at A&E.
EMAS’ Nurse Advisors team consists of 18 staff drawn from a wide diverse group both male and female, with various backgrounds and experience. Furthermore, we have employed staff that would not have been considered for appointment in other areas due to issues such as age and existing medical problems. EMAS is now keen to build on this foundation by actively encouraging staff from ethnic groups to join the team.
This scheme has allowed EMAS to reflect the needs of the communities, population and types of (patient) conditions that require our services. We also access the Language Line service approximately ten times a month to assist in the patient assessment process.
We have presented our work to the Trent Strategic Health Authority.
We share good practice with other ambulance services throughout the UK.
We have consulted with patients and other stakeholders to gain their views on the impact of our service changes and the new initiatives we have launched.
EMAS has positively embraced the changes introduced by the Department of Health by employing experienced staff and making best use of computerised software systems to ensure effective patient care is delivered.
EMAS was the first Ambulance Trust to make comprehensive use of Triage Nurses and pioneered the development of new referral options to deliver improved patient care and greater choice.
