Aims and objectives:
The aims of this service change are to ensure that patients received their care within the emergency care setting at the right skill level, in the right time and the right place.
In response to national changes that ambulance services implemented for patients with minor illnesses and injuries the model of nurse triage and links to five health communities allowed the Trust to work towards a model of care that supported 24/7 access to patients. This service change has allowed the networks to question duplication within the whole system and to raise the profile of a whole system of health and social care that has access 24/7, especially for unscheduled care.
Support for the change:
The project has been supported by the five ECN's that EMAS serves, EMAS PPI group, Boots plc, EMICS GP'S, 22 PCT's, STHA's, GP OOH providers and voluntary sector agencies.
Examples of good practice are:
1. Intermediate access points for older people so that they are not taken directly to A&E after a trip or fall.
2. Allowing our staff to help us create a model of care that is more appropriate for the patient through targeting direct access points to walk in centres, minor injury units and wards.
3. Strategically this change will ensure that patient pathways for social care and mental care will be explored in more detail at ECN'S
4. Learning has taken place between Boots plc and ourselves in terms of understanding our 'patients', 'customers', through segmentation and research & marketing models that the private sector adopt.
5. Modernisation tools and techniques have been adopted by the team. Tools such as SPC to understand our data, trends and variation; Discovery Stories by using the patients experience as a measure to success: Adopting process mapping to ensure that redesign takes place at every level of the system.
6. We have influenced our patients and our stakeholders in listening to the required 'need' of patients.
Patient and public influence:
The EMAS PPI group has been actively engaged in the project. Their input has been taken into account. The Lead Nurse supported by the Clinical Director regularly sample & measure patient/relative satisfaction levels. This allows the team and control staff to ensure that feedback is given within EMAS and partner agencies such as Social and Menta Care. A nurse undertakes an audit call back procedure within seven days of the call taking place as part of a peer review process.
Impact on the workforce:
Measuring the results:
Stakeholders are involved through the ECN's and OOH Providers and meet with the EMAS team on a regular basis. The results are measured on a weekly basis and shared with our partners. For instance in the month of October 492 ambulances (blue light) were cancelled and 153 calls were redirected using alternative transport i.e. PTS or redirected to MIU or Walk In Centre.
Improved performance:
Using SPC and specific demand criteria EMAS is refining a predictive model for resource allocation. Performance is measured using 20 variables that contribute to deviation, reducing these raises the success level in attainment of performance targets. This model is updated daily and planned over a 6 week rolling period. By forecasting need against demand, EMAS can deliver improving performance and patient care. Typically outstanding performance from this system can be measured using Category A & B, number of complaints, reduction in overtime costs, reduction in sickness and absenteeism etc.
Reflecting diversity:
The project takes into account the local needs of our population. The CATC staff are creating a directory of services for use by individuals that require specific care from their local community groups or where translation is required. EMAS control room uses Language Line to assist callers on-line that require immediate help. In 2005 the Trust will expand Language Line use to front line A&E crews.
Diversity issues are picked up internally by the Trust through its Equality Working Group, which is represented by the Chairman and Chief Executive. A support group for BME members helps redesign our services taking into account patients needs.
The Trust actively recruits staff from ethnic backgrounds, mirroring our communities through engagement and understanding.
Sharing the learning:
The project has been posted on the IPAS & EMAS websites and shared with other ambulance services. We facilitate a national forum looking at CATC and OOH issues, learning how other services address these topics and how we can avoid duplication but learn and move forward in a collective way.
Outstanding features:
There is a passion and drive within the team to move forward, to embrace new ways of working and alter the shape and form of our organisation to that of an Emergency Care Trust. Staff at the front line is hungry for the development of new skills and the time when they can resolve issues for patients within their homes rather than have to transport them to receiving units.
Working with Boots has enabled the team to think differently and use the expertise within a private sector company to expand our knowledge and to raise our awareness to the need for research and development within an organisation such as ourselves.
Finally the best feature has been to speak to patients within the audit and see that their need was met and they were thankful that they did not end up at A&E waiting on a trolley!
